HomeMy WebLinkAboutDisabilty_Waldroupi 1 � � ' '
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+f�,r 4 APPLICATION FOR BLIND OR
aT.r; •. DISABLED PERSOMS DEDUCTION
?;�-ti, : 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.
31e owner?
yes ❑ no
name on
coniract seller:
Is appiicant blind as defined in
IC 6-1.1-12-12(b)?
� yes � no
it no, wn
interest?
exact
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spouse, indicate with whom.
t2-1-1-t(n) & Is the applicant disabled and unable to engage in any
substantial gainful activity as defined in IC 6-1.1-12-(d)?
� yes j� no
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(s the property used and occupied primarily for his/her poes the applicanPs taxable gross income for the
res� nce? preceding calendar year exceed $13,000?
yes � no � yes (S(j no
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Taxing District Key Number/Legal Description Record No.
r� S S �' GLC� l 2/ I 3 Pf .
o....., ni..
UWe certify
�y
of perjury thai ihe a ove an oregoing information is true and correct and that the appiicant
and owner o( the aforemeniioned property on March 1, 19 .
Auihorized Represeniative (by executed Power of
Attorney)
s� .
oi Applicant ,� � Address