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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fortn a3770 (R4 / 70-07)
Presaibetl by ihe Department ol Loral Government Finance
COUNTY TOWNSHIP YEAR
I
��� "'mation contained in this dowment is CONFIDENTIAL pursuant to IC 72-7-1-1(n) and IC 6-1.1-12-12(b).
'RUCTIONS:
To be filed in person or by mail v�ith the County Auditor o/ lhe county where the property is located. AP R 2 5 2002
Filing Dafes: 1) Real Property: During the 12 months before May 1 i of the year the deduction is to be efle tive.
2) Mobile Homes assessedLnde� IC 6-1.1-7: Befween January 15 and March 31 ollhe ye�he deducU n i be e v cti .
See ieverse side foradditional instnictions and qualifications. GIBSON COUNiY AUDITOft
of
If name on record is diRer
� rC.LR.{�
Name of contract seller
Address of contracf seller
Is auolicant blind as defini
or conVact 6uyer)
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or equitable owneR If No, what is
❑Yes ❑No
:nt than that ot applicant, iqdicate below
❑ Yes ❑ No
It ownetl witn 5omeone
indicate vrith whom
Is the property in question:
spouu,
❑ Real Properiy ❑ Mobile Home pC 61.
disabled and unable to engage in any substantial gainful aCiviry
nIC 6-1.7-72(d)?
O Yes
the property used and occupied primarity for hislher residence? Dces the applicant's taxable 9ross income for the precedinq calendar year
, exceed 577,000?
es ❑ No ❑ Yes Jo
xing distriC Key number / Legal desaiption Record number Page number
'= —�O_— —_ �—��
I/We certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1. 20 _
�atye of appliwnt Signature of authorized representative "