Disabilty_Swope (2)�•"'"v APPLICATION FOR BLIND DISABLED P RSON'S couNTr TOWNSHIP � YEAR
" s`}_--. •� DEDUCTION FROM ASSE ALU
•. State Form a3710 (Ra I io-o7)
�'%.z"� Prescnbed by Ne Department of Local Govemment Finance
�ation contained in [his document is CONFIDENTIAL pursuant to IC 12-7-1-7(n) and IC 6-1.1-12-12(b) �� �
RUCTIONS:
To be filed in person or 6y mail with fhe County Auditor o( the county where the property is locafed. MAY 8 2Q02
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is o be effective.
2J Mobile Homes assessedLnder IC 6-1.1J: Between January 15 and March 31 � he year th� de�}�cfion i�o Gg ef/ective.
See ieverse
Name of
lor additional instructions and qualifications.
(owner or contracf buyer) _ �
ezaa
name on
❑ Yes ❑ No � `�
than that o( applicant, indicate below
Name of coniract seller
Addre of contract seller
� Q
Is appliqnt blin s d flned in IC 72-7-1-1(n) and IC 6-1.1-72-72(I
❑ Yes ❑ No
Is the property used and occupied primarity for his/her residence?
�� �i Yes ❑ No
i �
o(
as
GIBSON
I( owned with
indiwte with �
Is the property in Quesiion:
o I Real Property ❑ Mobile Home (IC G1.1-
t disabled and able to engage in any substantial gainful aa'rviry
in IC &1.1-12(d)? �
�Yes ❑ No
Does the appliwnt's taxable gross income for the preceding wlendar year
exceed 517,000? �
Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March t, 20 _
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