HomeMy WebLinkAboutDisabilty_JamesAPPLICATION FOR BLIND OR
.�•.°'?� County Township Year
d,w. 4g DISABLED PERSON'S DEDUCTION
�'. ;, FROM ASSESSED VALUATION
�.,. � ,•� State Form 43710(1-90)
`•—'• prescribed by the State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the
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.
Applicant (Owner or contract
equitab owner?
es ❑ no
If name on record differen
Name of contract seller.
Address of contract seller:
Is applicant blind as define
IC 6-1.1-12-12(b)?
� yes � no
or Iir no, wn
interest?
12-1-1-t
;�� ,-.Fylel�Aark
IyJS
� �-. ��
AUDITOR
ir ownea wim someone otne
spouse, indicate with whom.
ap icant disabled and unable to engage in any
ial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Is the prop y used and occupied primarily for his/her poes the �
residen � preceding
es � no � yes
iY axable gross income for the
r year exceed $13,000?
no
IlWe 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, 19
Authorized Representative (by executed Power of
Attorney)