Disabilty_Bostick�_ '"� APPLICATION FOR BLIND OR DISABLED PERSON'S couNTr TOWNSHIP re.nR
_. - ; DEDUCTION FROM ASSESSED VALUATION
State Pmn a3770 (R7 / 5-O6) /] I�
�li Pres�be.d b y Ihe De p a r U n e nt W Lofal G o v e r` v n r s t F i n a n c e � V�
�.�Information coniained in this document fs CONFIDENTIAL pursuan� to IC 72-b1-7(n) and IC 6-1.1-12-12(b).
'NSTRUCTIONS: ,IUN 5
To be liled in person or by mail with !he County Auditor o! the county where the property is located. 2��9
Filing Dates: 1 J Real P�operty: During the 12 months 6e7ore June 71 of the year the deduction is to be eNective.
2J Mobile Nomes assessed under IC 6-7. 7-7: During the 72 months 6efore March 2 0/ each yea� �ndiv" wishes to
obtain lhe deduction. � � ��
See reverse side (or addrtional inst�uctions and ualifica6ons. GIBSON COUNTY AUDITOR
Na of appliwnt (owner or conVact buyerJ �
nameon
or equitable owner? If No, what is
❑ Yes O No
ent ihan that of appficant, indiwte below
Name of contract seller
contract seller
Is applicant blind as defined in IC 12-1-
❑ Yes
Is the property used and occupied prim
1(n) antl iC 61.1-72-
❑ No
❑ No
exaU share o( interest? If owned v.ith someone other than spouse,
indicate wiN whwn
as
1
Is the property in question:
�Real Property ❑ Mobae Home (IC frt.
t disabled and unable to eryage in any subslantial gain(ul activi
in IC 61.1-12-71(d)?
❑ Yes ❑ No
gross income for the preceding calendar year
❑Yes ❑No
numher / Legat descrip6wi Rewrd number Page number
-ao -�8 -aoo_oo�.Yr ��o/
IIVJe certify under penalty of perjury thal the above and (oregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 -
ot applirani
X ��y/0 �. 900 5. F/%��el� ��/. �x�3
representative