HomeMy WebLinkAboutDisabilty_Gonzales� i .
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��,,,no APPLICATION FOR BLIND OR \"
a . � DISABLED PERSON'S DEDUCTION �a �
, , FROM ASSESSED VALUATION ��
� �.,: ` ,• State Form 43710(1-90)
'°' ' prescribed by the State Board of Tax Commissions�$
Instructions for filing: � J�
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.
buyer)
Is applicant the sole legal or I Vlf no, what is his/her exact
equitable owner? interest?
j� yes � no
7�
If name on record different than that of applicant,
of contract seiler:
contract
Is applicant bllntl as
IC 6-1.1-12-12(b)?
� yes �k� no
Y
County � Township
(��I��
t '� � _ � U�TJ
Year
If owned with someone other than
spouse, indicate with whom.
-1-1(n) & Is the applicant dfsabled and unable to engage in any
su st ntial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Is the property used and occupied primarily for his/her
re ce?
�yes � no
�_r�
Does the applicant's taxable gross income for the
preceding calendar year exceed $13,000?
� yes j� no
7'1
01(, -�aD39 P
f
- — — - Q oS� lJ.) � �-g .7a1 �C. Page No.
I/We certify under pena of perjury that the above and foregoing information is true and correct and that the applicant
was a resident of Indiana and owner of the aforementioned property on March 7, 19 .
Signature
3 � cAJ� (/.�ve
Authorized Representative (by executed Power of
Attorney)