HomeMy WebLinkAboutDisabilty_Hannah� c�
�n„� APPLICATION FOR BLIND OR County
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 ary� j{istructions. .
Applicant (Owner or contract
equita owner?
yes � no
If name on record different than that of applicant, indicate below:
Name of contract seller:
Address of contract sell�
Is applicant blind as d
IC 6-1.1-72-12(b)�
� yes no
Is the proBerfy used and occupied primarily for his/her
yes � no
Township
�AY 101995
� � o��
Year
If ownetl with someone othe
spouse, indicate with whom.
ap ant tlisabletl antl unable to engage m any
ial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Does the applicanYs
preceding calendar
[�' yes no
-00/� 1,
�gross income for the
exceed $13,000?
I/VVe certify under penalty of perjury that the above and fo�egoing information is true and correct and that the applicant
was a resident of Indiana and owner of the aforementioned property on March 1, 19
Signature I Authorized Representative (by executed Power of
_� _ � Attorney)