Disabilty_Wilson.. :.:
�°'°� APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43710 (R / 9-%)
�' � w � PrescriDed Gy the Slate Board of Tart Cammissroners
Ir�ation contained in this document is CONFIDENTIAL pursuant to IC 12-1 -�� di �
INSTRUCTIONS FOR FILING:
To be Iiled in person or by mail with the County Auditor o! the cio ty wh r�r5
ted du�ing the 12 months be%re May 77 0! the year the deducti n is to be rve
See reverse side lor additional insfructions and qualilirations. /`
Name o licant (owner or contract buyer)
/�� /� GIBSON
�/I�G (/v_ �//LS�
Is applicant the sole legal or equitable owner? tl No, what is his/her exact share of
I�Yes ❑ No
name on record is diNerent than that of applican
ame oi conVact seller
idress of contract seller
applicant blind as defined in IC 12-1-7-1(n) and
❑ Yes �lo
Ne properry used and occupied primarily.for his
� f�'S'es ❑ No
unng tlij Mct �
/17/1�^-�.J �L � \'
as defined in IC�6-7.
Does the applicanYs
exceed $17,000?
ni(n (if 7_ V l'I
courrrv
File Mark
9�� A��
MAY 0 6 ��y��
YEAR
otherthan spouse,
I and unable ro engage in any sub�,taniial g�
1-12(d)?� � ❑ Yes�• ❑ No
income
❑ Yes
year
I/We certify under penalty of perjury that ihe above and foregoing information is true and correct and that the applicant was a resi-
dent o( Indiana and owner'oi the atorementioned property on March 7, 19 _
