HomeMy WebLinkAboutDisabilty_Goodman� APPLICATION FOR BLIND OR DISABLED PERSON'S
:y ,- � DEDUCTION FROM ASSESSED VALUATION
State Fotm a3710 (R / 9-96)
',�,��� Prescnbed by the State Board af 7ax Cammissioners
i��ormation coniained in this document is CONFIDENTIAL pursuant to IC 12-t-1-1�n) and IC 6-7.7-72-12(b).
INSTRUCTIONS FOR FILING:
To be �iled in person o; by mail with the Counry Auditor o1 the counry where the property is loca-
ted during the 12 months before May 71 0/ the year the deduction is to be eflective.
See reverse side lor additional instructions and qualilications.
ame of applicam (owner or conhact �
� �� �l__N
applicant the sole legal or equitabie
�
name on record is diNerent than hat
ame of contract seller
idress ot coniract seller
whai is hisfier exact
whom
Is applicant disabled and unable to engage i�any� ubsianiial gainful aaiviry
as detined in IC 6-1.1-72(d)? I�Ngs ❑ No
`7'
gross
❑ Yes
year
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi- •
dent of Indiana and owner of the aforementioned property on March 1, 19 �
�