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� APPLICATION FOR BLIND OR DISABLED PERSON'S To I � YEAR
.! � DEDUCTION FROM ASSESSED VALUATION
State Form 437� 0(R / 9-96)
,,, d Prescribed by the State Boartl of Taz Commissioners
Irlformation contained in this document is CONFIDENTIAL pursuant to IC 72-t-t-7(n) and IC 6-7.1-72-12(b). F� Mark
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with ihe Counry Auditor ol the counry where the p�operty is loc GIBSON COUt�TY AUDIT�a
ted during the 12 months be%re May 17 0/ the year the deduction is to be eflective.
See �everse side for additional instructions and qualifications. ,
exact
❑ Yes ❑ No
If name on record is diflerent than that of applicant, indicate below
contraa
applirant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-72-12(b)?
P�oPertY
O Yes ❑ No
❑No O/�—�/�
If ownetl vrith someone other than spouse,
indicate with whom
applicant disabled and unable to engage in
defined in IC 6-1.1-12(d)? �
gross
❑ Yes
ntial gainful activiry
❑ No
year
I/We certify under penalty of perjury ihat the above and toregoing iniormation is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 _
of applicant
�
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