HomeMy WebLinkAboutDisabilty_Laswell_..
�° �" APPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
Siate Form 43710 (R / 9-%)
�' �� Presaibed by the State Board of Ta< Commissioners
I�atlon contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-7 (n) and IC 6-1.1-12-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the counry where the property is loca-
ted during the 72 months belore May 17 0/ the year the deduction is to be el%ctive.
See reverse side lor additional instructions and qualifications. /
Name ot applicant (owner or contract buyer)
Is applicant the sole legal or equitable owner? It No, what is hisiher
❑ Yes ❑ No
If name on record is diflerent than that of applicanL indiwte below
Name of contract seller
Address ot coniract seller
as
properry
���'
��;w' -;�� -
.. :�a
-� ,
MAY 0 8 1991 �
GIBSON
I wlth someone other [han spouse,
wiih whom
IG 12-7-1-1(n) antl IG 6-1.1-12-12(b)? Is applicant tlisabled and unable to engage in any substantial gainful activi�
as defined in IC 6-7.7-72(d)? ❑ Yes ❑ No
❑ Yes ❑ No
ied primarily. for his/her residence? Does the applicanYs taxable gross income for the preceding calendar year
ezceed $77,000?
❑ Yes ❑ No
number / Legal description
❑ Yes ❑ No
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 propeAy on March 1, 19 _
a�� �
��� �
�