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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 _