Disabilty_Farmer- ��.,
�
�" °'" APPLICATION FOR BLIND OR DISABLED PERSON'S courrtr TOWNSHIP YEAR
:! -- 4 DEDUCTION FROM ASSESSED VALUATION
State Form a3770 (R / 9-96)
�' ,� � Prescribed by the State Board ot Tax Commissioners
�...�rthation contained in this documeni is CONFIDENTIAL pursuam ro IC 12-7-1-t (n) and IC 6-7.1-12-12(b F a
INSTRUCTIONS FOR FILING: MAY O% ZOO�
To be liled in person c; by mail wiih the County Auditor o1 the counry where the property is loca-
ted during the 72 months belore May i l of the year the deduction is to be eNective. /'� //
See reverse side lor additional instructions and qualilications. /� . / y� /J �
or
es ❑ No
It name on record is ditterent than that of applicant,
�'l._
CQ7L�'_%U1`k�2.�
o, whai is hislher exact share ol
blind as defined in IC 12-1-1-1(n) and IC 6-7.7-72-1
property
❑ Yes C�FF�
eL9'Y s ❑ No
GIBSOn
i with someone other than spouse,
with whom
disabled and unable to engage in�any subst ial gainful activity
n IC 6-7.7-12(d)? � e[L�.�� No
tanabie gross income for the preceding calendar year
❑ Yes ❑ No
Record number Page number
I/We certify under penalty of perjury thal the above and toregoing information 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
m
s of applicam
5�
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