HomeMy WebLinkAboutDisabilty_Gastonf �•�
�3� APPLICATION FOR BLIND OR DISABLED PERSON'S
} DEDUCTION FROM ASSESSED VALUATION
�i �
• State Form 43710 (R / 9-96)
�' PresaibeG by tha State Board of Taz Commissioners
Ir�tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ot the county where the property is loca-
ted during the 12 months belore May 11 0l the year the deduction is to be ellective.
See reverse side lor additional instructions and qualifications.
mer or contract
Is applicani the soie legal or equitable owner?
❑Yes ❑No
If name on record is different than that of applican
contraa
ot contraa seller
as
P�aPehY
❑Yes ❑No
❑ No
No,
c�
C
a
$1
courrrv
�g i18��
A
.E-
MAY 0 6 1991
YEAR
It ownetl with someone other than spouse,
indicate with whom
I tlisabletl antl unable to engage in any substantiai gainful activiry
in IC 67.1-12(d)? ❑ Yes ❑ No
taxable gross income tor the preceding calendar year
❑ Yes ❑ No
Record number Page number
� '� �1 l—O�I !�� —��
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 atorementioned property on March 1, 19 _
�ature of applicant , Signature of authorized representative (by executed Power olAttomey)
of licant Addreu of authorized representative
8z s �! �'��� .�