Disabilty_Wilkinsons.
�- �
��R„�4 APPLICATION FOR BLIND OR
: a,�. � DISABLED PERSON'S DEDUCTION County Township Year
', — FROM ASSESSED VALUATION
��.;. 1ef=;:� State Form 43710(1-90) �� �y �
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 buyer) (�
�T"�-�-
Is applicant the sole legal or If no, wh
equitab owner? interest?
yes ❑ no
name on record different than that
Name of coniract seller:
contract
Is applicant blind as
IC 6-t.t-12-12(b)?
� yes � no
2-1-1-1(n) &
Is the pr perty used and occupied primarily for his/her
reside e?
yes � no
Taxing District Key Number/Legal
[�.AY _ F�f��*
Q.w,,,v p O�s
lf owned with someone othe
spouse, indicate with whom.
Is the ap licant disabled and unable to engage fn any
subst ial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Does the applicanYs t xable gross income for the
preceding calenda ear exceed $13,000?
� yes no
O U I Page 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)
a. ��1