HomeMy WebLinkAboutDisabilty_Sandefur'' bPPLICATION FOR BLIND OR DISABLED PERSON'S ��
, , } DEDUCTION FROM ASSESSED VALUATION �.
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State Form 43710 (R / 9-96) \
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�' ,�a � Prescribed by Ne State Boartl ol Tac Commissioners �/�
� Ir�tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-12-72(b).
INS i RUCTIONS FOR FILING:
To be liled in persan or by mail with the CountyAuditor ol the county where the property is loca-
ted during the 12 monihs be%re May 11 0/ the year the deduction is to be eflective.
See reverse side Ior additional inshuctions and qualilications.
� of applicani (owner or contract
; h�21.� s
dicaN the sole leqal or equitable
Yes ❑ No
name on
Name of coniract seller
as tletinetl in IG 72-1-7-1IN antl 12 6-1.7-7
exact
'OWNSHIP yEAp
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File Mark (�
�_H!� "
.�, �1
If owned with someone other ihan spouse,
indicate with whom
applicant disabled and unable to engage in any stanlial q�
� defined in IC 6-1.7-12(d)? es ❑ No
❑Yes �No
Is the properry used and occupied primarily. tor his/he� residence? Does the applicanYS taxable gross income for the preceding calendar year
exceed $17,000?
� Yes ❑ No ❑ Yes � No
T istr' r Key number / Legal descriptlon Record number Page number
�3`� -�-��-�-�
IIVJe certify under penalty oi perjury that the above�and foregoing information is true and correct and that�the applicant was a resi-
dent of Indiana and owner'oi the aforementioned property on March 1, 19 _
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