Disabilty_Schmitt�`°�%- �� APPLICATION FOR BLIND OR DISABLED PERSON'S couNTr TOWNSHIP v�
�1� DEDUCTION FROM ASSESSED VALUATION ///���
S�ate Fortn d3710 (R775-O6) � �
�
PresWmd by Ihe Deparhn�t W Local Govemment Finance
Information contained in this dowment is CONFIDENTIAL pursuant to IC 724-1-1(n) and IC 6-7J-12-72 ). Fil Ma
INSTRUCTIONS:
To be /iled in pe�son or by mail with the Counly Auditor o/!he county where the property is locafed.
Filing Dales: 1) Real Property: During !he 12 monfhs before June 17 ot the year the deduction is l0 6��c�ve1 2��9
2) Mobile Homes assessed under IC 6-7.1-7: During fhe 12 months before March 2 of each year the individual wishes to
obtain the deduction. �i�
�ee reverse side (or addrfional inst/uctions and qualrfica6ons �"
'ame ot apphcant (owner or rnntract buyerJ s
C� C.1 O � �.J GIBSON COUN7^ Y AU��
Is applicant the sole legal or equitable r? IIf No, i
es p No
If name on rewrd is different than that of applicani, indicate
Name of conUact seller
4ddress o( conVact selier
Is applicant blind as de(ned in IC 12-1-1-1(n) and IC 6-1.1-�
ihe
❑ Yes ❑ No
ed orimariW for hislher
es ❑ No
exaU share of
ovmed with someone
diwte with whom
Is the property in question:
spouse,
❑ Real Property ❑ Moble Home (IC &7.
Is applicant disabled and unable to engage in any su tantial gaintul activi
as defined in IC 6-1.1-12-77(d)?
es ❑ No
Does �he applicanCs taxable gross income for the preceding calendar year
exceetl 517.000?
❑ Yes No
descripfion Record number Page number
�/l/�f 1 S.//1/1.
IM/e certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
of aPPfipnt
�.?G 7 !✓ 9'.SUS. DsoeNJ�i /��
ot authorized
representa6ve