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e�"�c+ APPLICATION FOR BLIND OR DISABLED PERSON'S
:!� DEDUCTION FROM ASSESSED VALUATION
� � State Fortn a3710 (R / 9-96)
�,� Prescnbed by Ihe State Board ol Tax Commissioners
�mation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7
INSTRUCTIONS FOR FILING:
COUNTY TOWNSHIP YEAR
� 1� � � �
File Mark
,-,2-,2,b,. q?� 02 1998
To be /iled in person o; by mail with the County Auditor ol the counry where the property is loca-
ted during the 72 months be%re May 7 7 0l the year the deduction is to be elfective.
See reverse side lor additional instructions and quali�ications.
name on record is
� or conhact Duyer)
�
�
or equitable owner? If No, what is
Yes ❑ No
ent 4-applirant, indicate below
.��'��� �
Name ot coniraa sener
Address of contract seller
Is applicant blind as defined in IC 12-1-1-t�n) and IC E7.t-12-72(b)?
❑Yes ❑No
Is the property used and occupied pnmarily for his/her residence?
� ❑Yes ❑No
Ta�cing district Kp�p r I!
�t���i�s Q�u.�/,�. vu�
_�/ �.t �:
GIBSON (
exact share of interesi?. If owned with someone oiher than spouse,
indicate wlth whom
applicant disabled and unable to engage in�any substantial gainfuhactiviry
� defined in IC 6-7.7-72(d)? � Yes ❑ No
- o%.-i
gross
preceding calendar year
❑ Yes ❑ No
- Paqe number
I/We certify under penalty of perjury that lhe above and foregoing information is true and correct and that the applicant was a resi-
dent ot Indiana and owner of the aforementioned property on March 7, 19 �
ot applicant
of applirant