HomeMy WebLinkAboutDisabilty_Brown��,�„�� APPLICATION FOR BLIND OR
e� �.
DISABLED PERSON'S DEDUCTION County Town ' Year
�. , FROM ASSESSED VALUATION
+.,. , ;; s State Form 43710(1-90)
'°" Prescribed by the State Board of Tax Commissioners ,
i�lt 12 199
Instructions for filing:
To be filed in person or by mail with the County Auditor of ihe
county where the property is located during the 12 months before
May 11 of the year the deduction is to be effective. See reverse
for additional qualifications and instructions.
or
Is applicant the soie legal or
e wt le owner?
�yes ❑ no
�.v�
contract
seller:
Is applicant blind as defined
IC 6-1.1-12-12( )?
� � yes no
If no, whTs his/her exact
interest?
/_l File M�,ark��J
��
AUD►f �R
If owned with someone other than
spouse, indicate with whom.
12-t-1-1(n) & Is the applicant disabled and unable to engage in any
s b�tial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Is the property used and occupied primarily for his/her
resi�ce?
yes � no
Taxinq District Key Number/Legal
Does the appiicanYs taxable gross income for the
preceding calen ar year exceed $13,000?
� yes no
Record No.
IlWe certify under penalty of perjury that the above ar(dlforegoing information is true and correct and that the applicant
was a resident of Indiana and owner of the aforementioned property on March 1, 19 �
Authorized Representative (by executed Power of
Attorney)