HomeMy WebLinkAboutDisabilty_Fahrner' -��� .�
.: ..,
"'°�A APPLICATION FOR BLIND OR DISABLED PERSON'S
;� -.- � DEDUCTION FROM ASSESSED VALUATION
Scate Fortn 43770 (R / 9-96)
�' ,� � Prescribetl by t�e State Board ot Taz Commissioners
Intormation contained in ihis documeni is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-72-12(b).
INSTRUCTIONS FOR FILING:
To be liled in peison or by mail with the County Auditor of the county where the property is loca-
ted during the 72 months be%re May i l ol the year the deduction is to be eflective.
See reverse side lor additional instructions and qualilications.
of applicani (owner or contract buy&) ,
or
r — `� . v—v�+�
his/her exact share of interest?
❑ Yes �'No �
If name on record is different than that of applicant, indicat below �
�
of contraa seller
wntrad
Is appliram blind as defined in IC 12-7-1-1(n) and IC
❑ Yes
used and otcupied prirt
❑ No
2(b)? I Is applicant disabted and un
as defined in IC 6-1.7-12(d)?
�
JUL 0
i wnn someone omer [nan Spouse.
with whom
abie to engage in any stantial g;
' es ❑ No
gross income for the preceding cal
❑ Yes '� No
I/We certify under nalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a resi-
dent of Indiana an owner of the aforementioned property on March 1, 19 �