HomeMy WebLinkAboutDisabilty_Nixonl, �� .
°"" APPLICATION FOR BLIND OR DISABLED PERSON'S
.;. .� k DEDUCTION FROM ASSESSED VALUA ON, n/!11
�� State Form 43710 (R / 9-%) �
�' u� Prescn6ed by the State Board of Tax Commissioners
I��aGon wntained in Nis dceumeni is CONFIDENTIAL pursuant to IC - 1-1(n) C i
INSTRUCTIONS FOA FILING:
To be /iled in person or by mail with the County Auditor ol the cnun h
ted du�ing the 12 months be%re May 11 0( the year the deduction is t b e' e
See reverse side !or additional instructions and quali/ications.
� applicant the sole lan�i�� �+�
�
narne on record is diNerent thai
ame of convact seller
ddre55 of contraCt seller
owner? I If No, whai is
❑ No
a � -�y-i 9-ia a -�
as defined in IC 12-7-7-1(N and IC 6-1.1-
❑ Yes No
the property used and occupied primarily. tor his/her residence?
� es ❑ No
disirict
\ 1
I/We certify unc
dent of Indiana
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exaa
courm
D (I
�, ,�L. x.r �� a
APR 2 2 1997 �
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. 7� 9 -cr� 7
� Is applipnt disabled and unable to engage
as defined in IC 67.7-72(d)?
gross
-V�EAR
I �
otherthan spouse,
❑ No
r me preceoing caienaar r
O Yes o
Key number / Legal description Record number Page number
_�-I_ Lo _- 0 a �(0 4- 0 cO
oi perjury that the above and foregoing information is true and correct and that the applicant was a resi-
'of the aforementioned property on March 1, 19 _
Signature of authorized representative (by executed Power olAttomeyJ
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