HomeMy WebLinkAboutDisabilty_Hunt�°' "'" APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
�• State Form 43710 (R / 9-96)
� Prescribed by the State Board of Tav Commis5ioners
Information contained in this document is CONFIDENTIAL pursuant to IC 12-7-7-7(n) and IC 6-7.7-72-12(b).
INSTRUCTIONS FOR FILING:
To be filed in person c r by mail with the Counry Auditor of the county where the propeRy is loca-
ted during the 72 months before May 17 0l the year the deduction is to be eflective. /
See reverse side for additional instructions and qualifications. ��
Name ot applica (ow er or cont�act buyer) � / `
or
' L�(i'es ❑ No
If name on record is ditterent t n ihat of applicant,
contraa
applicant blind as defined in IC 12-1-1-t(n) and IC 6-1.7-12-1
P�aPenY
❑Yes ❑No
ied primarity for his/her residence?
❑Yes ❑No
Key number I
/ /�`-> -
exact
as defined in IC 6-1.
Does the applicanYs
exceed $77.000?
descripGon
��/-�.
COUNTY TOWNSHIP YEAR
`-� i� �'`�
-%.' ,. • i '; Eil'e. M�fi
I�AY i 0 2000
I with someone other ihan spouse,
with whom
to engage in �any substantial gainful activity
❑Yes ❑No
taxable gross income for the preceding calendar year
❑Yes ❑No
Record number Page number
I/We certify under penalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a resi-
dent of Indiana and owner oi the aforementioned property on March 1, 19 �
ot applicant
�/1- /✓ , i^`�"v'�iV
of appiicant "�
dl � I JOGi` �/ /I //✓G e J�,
Power o(Attorney)