Disabilty_Ghanta°"'> APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr � TOWNSHIP
. � DEDUCTION FROM ASSESSED VALUATION
�'• D - State Fofm a3770 (R4 / 70-07)
�'%.�: ' Presaibetl Dy the Department of Local Government Finance
�ation contained in this document is CONFIDENTIAL pursuant [o IC 12-1-1-7(n) and IC 6-7.1-72-72(b). rk
lf�TRUCTIONS:
To be filed in person o� by mail with the County Auditor of the county where the property is locafed.
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 0( the year the deduction is to be ���ti�.4 2002
2) Mobile Homes assessedunder IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is to
See ieverse side for additional insfnictions and qualifications.
Is
owner? I If No. what is
❑ Yes ❑ No
on record is drflerent than that of applican
applicant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-1
❑ Yes D'No
property used and occupied primarily for his/her residence?
LY�'es ❑ No
Taxing district
Dces the �
exceed 57
GIBSO�I
YEAR
.—
If owned with someone o[her than spouse,
indicate w@h whom
IIs the property in question:
L�'F2eal PropeAy O Mobile Home QC G7.1-�
t disabled and unabie to engage in any substaniial gainful aGiviry
in IC Cr1.1-12(d)?
yres ❑ No
pplicant's taxable gross income for the preceding calendar year
O Yes �No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
representative
authorized representative
Q. R;2.. Sox 67,0,i t� ��;�!►�+.i o