Disabilty_Lloyd t+ \. 3. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
r DEDUCTION FROM ASSESSED VALUATION
`_ State Faun 63710(R9/9-08)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Ring Dates: 1) Real Property:During the year for which the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Props During the twelve(1 2)months before
March 31 of each year the individual wishes to obtain the deduction.
ILED
See reverse side for additional instructions and qualifications.
Name of (owner or contract buyer) 4
SEP 19 2013
Is applicant legal or equtabl owner? If No, is his/her exact share of interest? If owned with other than spouse,
indicate with
Ej s ❑No GIBSON rnLMTY AUDITOR
If name on raced is different than that of appaant indicate below
Name ot�am�s I /
Address of intact sailer(nun,.: aid street,dry,state,and ZIP code) ( Is the property in question:
❑ Real Property ❑ AnnuallyAssessed
Mobile Hare(IC 6-11-7)
Is applicant blind as defined in IC 12-7-2.21(1)? I tyt tal-tta a to engage in any substantial acthrity
❑Yes No Yes ❑No
Is the property used and occupied primenly for hist er residence? exceed 5 Does the 77,000?appll ant%taxable grass income for the preceding calendar year
❑Yes El No El Yes No
Taxing district
applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
d applI ant Address of applicant (number and street,wry,state,and ZIP code)
t ! �Q�(MI
udnr¢ed Address of authorized representative (number and street,city state,and ZIP code)