Disabilty_Woodburn;�..
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�,,,,� APPLICATION FOR BLIND OR
_ a ,�: °� 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 (�ner or contract
�cam �e so�p_wgai or ir no, wn,
�le owner? � interest?
yes ❑ no
ir ownea witn someone ome
spouse, indicate with whom.
If name on record different than that of applicant, indicate below:
Name of contract seller:
Address of contract seller:
Is applicant blind as defined in IC 12-1-1-7 (n) & Is the applicant disabled and unable to engage in any
IC 6-1.1 -12(b)? substantial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no � yes � no
Is the property used and occupied primarily for his/her
reside e?
yes � no
P-�-�
Does the applicanYs able gross income for
preceding calend ear exceed $13,000?
� yes no
Key Number/Legal Description
Record No.
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the appiicant
was a resident of Indiana and owner of the aforementioned property on March t, 19 .
Signature
Authorized Representative (by executed Power of
Attorney) ��
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