Disabilty_Murnahan�`��~• APPLICATION FOR BLIND OR DISABLED PERSON'S cour+Tr TOWNSHIP YEAR
. 1��� DEDUCTION FROM ASSESSED VALUATION
' Sfate Form 4J710 (R7/5-06)
'�� Resaibed � Ihe De �
y p.-�M�ent W Loral Govemment Fnunce
�Information contained in this documeni is CONFIDENTIAL pursuant to IC 12-1-t-1(n) and IC 6-7.1-12-12(b). File Maiic
1NSTRUCTIONS:
To 6e liled in person or by mail with the County Auditor ol the county where lhe property is locafed.
Filing Dates: 1) Real Property: During (he 12 months befo�e June 11 of fhe ye n i ve.
2J Mobi/e Homes assessed under IC 6-1_ 7-7: During the 72 mont f �ch a ye (he individual wishes to
^ . _oblain the deducfion. ��� �
Name of appiican (ow .r or conVact I
Is appliwnt Ne ml lega or equitaWe
_ Q.V�
If name on record is difterent ihan that
Name of conirad seller
Address of contract seller
" OCT 0 4 2007
,
�r? I( No, what s hislher exacl share of interesL • with w5homeone o[her than spouse,
/ GIBSON COU ��' �I�Oti �m
❑ No
�plicant, indicate below
Is the property in quesUOn:
appliwnt blind as deGned in IC 72-t-1-7(n) antl IC 6-1.1-12-12(
❑ Yes ❑ No
Ihe property used and occupied primarily for his/her residence?
distriG
�
❑ No
INVe 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 applicant
( `/ `
m
rthorized representative
norized represeniative
z�l6�S