HomeMy WebLinkAboutDisabilty_Weyerr �
�'°�A APPLICATION FOR BLIND OR DISABLED PERSON'S courm TOWNSHIP vena
.t � DEDUCTION FROM ASSESSED VALUATION
Sute Form a3770 (R / 9-96)
�' � Prescribetl by the State Board of Tac Commissioners
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In�tion contained in this documeni is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.7-72-12(b). ����
INSTRUCTIONS FOR FILING:
To be liled in pe�son or by mail with the Counry Auditor o� the counry where the property is loca-
ted during the 12 months belore May i l ol the year the deduction is to be eI/ective. �B O� 1997 ,
See reverse side (or additional instructions and quali(rcations.
of appiicant (owner or aontract 6uyer)'
�Q �Oil Ne-�SIP.�./
icant the sole legat or equitab�e owner?
La'%s ❑ No
nameon
is hisRier exact share of
that of applicant, indicate beiow
Name ot contract seller �T.�._ - —
NI�
Address of contract seller
Is applicant blind as defined in IC 12-1-t-1(n) and IC 61.1-12-72(b)?
Ly"1'es ❑ No
�° GIBSON COUN1
It ownetl vnth SOmeOne Other than SpouSB,
indicate with whom
l tlisabletl and unable to engage ln any substantial gainful activiry
�n ic s-�.i-�2�d�? C3,Yes' ❑ No
the property used and occupied primarily. for his/her residence? Does the applicant's taxable gross income tor the preceding calendar year
exceed $77,000?
es ❑ No � ❑ No
.y distria Key n�� �gal description Oa � Record number Page number
DQo�� —
� � �Oo�-oo.a5.7-o0 ;,
I/We certify under penalty oi perjury that the above and foregoing intormation is true and correct and that Ihe applican[ was a resi-
dent of Indiana and owner'oi the aforementioned property on March 1, 19
authorized representative (by ezecuted Power ol
of authorized representative