Disabilty_Hinton� n�
yS ��, :
APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
S�ate Fortn a3770 (R4l 70-01)
Prescribe0 by the Department of Local Govemment Finance
COUNTY TOWNSHIP YEAR
�-`^�nation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.7-12-12(b). File Mark
�RUCTIONS: —"'� �
�� �
o be filed in person or by mail with the County Auditor ol the county where the property is !o e '�
Filing Dates: 1) Real Property: During the 12 months before May 11 07 the year the deducfio� 6�e c�ve.��
2) Mobile Homes assessed�nder IC 6-1.1-7: Between January 15 and March 31 0l theJ H IV thg,deducfiqn is to be ef/ective.
G LUUJ
See reverse side for additional instructions and qualifications.
or contract
Is applicant the sole legal or equitable
❑ No
name on
GIBSON
If ownetl with someone
indicate with whom
property in question:
spouse,
O Mobile Home (IC 61.
Is applicant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-12(b)? Is appli�ant disabled and unable to engage in any substantial gainful aCivi
_ as defined in IC 6-1 J-12(d)?
❑ Yes �No Yes ❑ No
Is the property used and occupied primarily for his/her residence? Dces ihe applirant's taxable gross income f r the preceding calendar year
exceed 517,000?
es ❑ No ❑ Yes No
Ta�cfpg district � Record number age number
I/We certify under penalty of perjury that the above and foregoing information is true and corred and that the applicant was a resi- :
dent of Indiana and owner of the aforementioned property on March 1, 20 _ .
� � �,X 3\�-1 �c�.x�c�svo � �
