Disabilty_Strickland"'" �`' APPLICATION FOR BLIND OR DISABLED PERSON'S
�� :�i . - � DEDUCTION FROM ASSESSED VALUATION
State Fartn 43710 (R / 9-%)
�' y,� � PresuiDed Dy Ne State Board ot Tax Commissioners
Ir�ation contained in this document is CONFIDENTIAL pursuant to IC 12-t-1-1(n) and IC 6-1.7-72-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 12 months be(ore May 77 0/ the year the deduction is to be elfective.
See reverse side for additional instructions and qualifications.
or
l�1 Yes ❑ No
name on record is diHerent than that of applicant,
comrect
contract
If No, what is hi5/her
�
Is applicant blirM as defined in IC 12-1-7-1(n) and IC 6-1.1-72-72(b)? I5 applicant disabled and une
as defined m IC8-1.1-12(d)?
❑ Yes No
Is the property used and occupied primarily. or his/he� residence? Does the applicanYs taxable
ezceed $17,000?
� Yes ❑ No
Taxi istria Key number / Legal descrip6on
a�� �bl -�(�99 - oc�
MAR 0 5 1999
GIBSOt4
I with someone other than spouse,
with whom
to enga9e in� a�}�' substantial gainful
�Yes ❑ No
gross income for the preceding calendar year
❑ Yes � No
number ge number
I/We certify under penalty of perjury that the above and foregoing iniormation is true and correct and that the applicant was a resi-
dent of Indiana and owner'of the aforementioned property on March 1, 19 _
representative (by executed Power olAttomey)
i
apresentative ��