HomeMy WebLinkAboutDisabilty_Williams� 4 APPLICATION FOR BLIND OR County Townshi Year
d � �'� ,� DISABLED PERSON'S DEDUCTION
' :, FROM ASSESSED VALUATION
�\ State Form 43710(1-90) -'�
� �`^" Prescribed by the State Board of Tax Commissioners 2 7 199 i
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
or
e4�uit le owner?
y(� yes � no
��
If nam�qn rec��ferent
I �`� °f'
Name of contr ct seller:
Address of contract
Is applicant blind as
IC 6-1.1-12-12(b)?
� yes � no
interest?
that
exact
below:
File M�ark
AUD��.,,.<
ITO�R �-�
it ownetl with someone otne
spouse, indicate with whom.
.' -
-1-1(n) & Is the applicant disabled and unable to engage in any
substantial gainf activity as defined in IC 6-1.1-12-(d)?
� yes no
Is the property used and occupied primarily for his/her
resid ce?
�yes � no
Does the applicanYs taxable gross income for the
preceding calendar year exceed $13,000?
� yes � no
. i�
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
Authorized Representative (by executed
Attorney)
Address of