HomeMy WebLinkAboutDisabilty_Thurston> �,;;n APPLICATION FOR BLIND OR
a`' .: '4q DISABLED PERSON'S DEDUCTION
�. FROM ASSESSED VALUATION
�.,, ` , � State Form 43710(1-90)
'•-�" prescribed by the State Board of Tax Commissioners
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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.
County Township Year
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JUN 2 8 1996
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AUDITOR
Appy�ant (Owner or�ontract b�ye� _�
/�oSS' E ��AttLA S �r.��2s-, e
Is applicant the sole legal or If no, what is his/her exact share of If owned with someone other than
equitable owner? interest? spouse, indicate with whom.
[�yes � no
If name on record different than that of applicant, indicate below:
Name of contract seller.
Address of coniract seller:
Is applicant blind as defined in IC 12-1-1-t(n) & Is the applicant disabled and unable to engage in any
IC 6-t.t-12-12(b)? substan' I gainful activity as defined in IC 6-t.t-12-(d)?
�yes � no yes � no
Is the property used and occupied primarily for his/her poes the applicanYs taxable gross income for the
reside e? preceding calend year exceed $13,000?
�yes � no � yes �o
Taxing District Key Number/Legal Description Record No.
�i...ic.cT�..l O/rj'- Oa 8��- o� Page No.
I/We 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��.
Sig ature Authorized Representative (by executed Power of
��� p � � � � Attorney)
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Address of Applicant Address of Representative
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