Disabilty_Lindauer'°" APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr
DEDUCTION FROM ASSESSED VALUATION
� , State Form <3710 (RS! 603)
Prescnbed Oy the Department o( Lacal Govemment Finance
I�"-nation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-7(n) and IC 6-7.1-72-12(b). �
�22UCTIONS:
To oe filed in person or by mail with the County Auditor of the counry where the property is located.
Filing Dates: 1) Real Property: D�ring the 12 months before May 11 oI the year the deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0/ each year t
obtain the deduction. �
� �
Is applicant the sole Iegai or e table owner? If No, wha is hislY
Yes ❑ No
If name on record is difterent lh n ihat of applicant, indicate below
�.
Name of conVact seller
� I �`- ai �-/ �-
Address of contract seller
Is appliwnt blind as de5ned in IC 12-7-7-1(n) and IC 6-1.1-12-12(b)?
❑ Yes �lo
Is the property used and occupied O�marily for hisTher residence?
❑ Yes ❑ No
Taxirg district Key number / Leg
exact share
TOWNSHIP YEAR
�'I�� � �
3r aE dua�W;s�n��r
GIBSON
with someone oiher than spouse,
with whom
- Q -ooO �/5 8'
Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC E1.1
Is applirant disabled and unable to engage in any substantial gainful activit
as defined in IC 6-1.1-12(d)? �
�,Yes ❑ No
gross income (or the preceding plendar year
❑ Yes L�lo
Record number Page number
Otf'v/�-"`''`�" I rVl:l - VC7_�J7_�--c� I I
IIVJe certify under penalty of perjury that [he above and foregoing infortnation is true and wrrecl and that the applicanl was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
representaWe
c
applicant v �Address of authorized representative
3�� /tl _� �. rr� S'r r'r. BRAN�