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�" APPLICATION FOR BLIND OR DISABLED PERSON'S
;, � DEDUCTION FROM ASSESSED VALUATION
Stata Fortn a3770 (R / 9-96)
�' � a � PrescriheE by the State Board of Tan Commissioners
i�alion contained in this document is CONFIDENTIAL pursuant to IC 12-7-7-1(n) and IC 6-7.7-12-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o! the county where the property is loca-
ted during the 12 months belore May i l ol the year the deduction is to be eHective.
See reverse side lor additional inshuctions and qualilications.
Is applicant the sole legajyr.a�eile6fe'OWher?
❑Yes ❑No
If name on record is diHerent than thai of apolican
contract
ot contred seller
as
P�oPertY
❑ Yes ❑ No
❑ Yes O No
Key number / Legal
as defined in
Does the applicanYs
ex�ea s� �,000?
���
w r� :Y i:wi:��
i • �.
i y ° �.�
MAY 1 1 1998
� . �. /! 1/
�:i .�/�.- -v
I�'S0' � i;t7TY.hUDITOR�
�
I with someone other than spouse,
with whom
I and unable to engage in any Wnlial gainfut activi��
7-72(d)? es ❑ No
tanable gross income tor the preceding cal/en�ar year
❑ Yes VJ�No
I/We certify under penalty ot perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent o( Indiana and owner'of the aforementioned property on March 1, 19 _
S.lf �l�Q �"�OJwi�CJO'� .�/�l• � �
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