HomeMy WebLinkAboutDisabilty_Vickers,� ,
°"' . APPLICATION FOR BLIND OR DISABLED PERSON'S
r� _- 'i� DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (R / 9-96)
S y,� � Presaibed by the State Boartl ot Tax Commissioners �.�
Ir.�tion contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-1(n) and IC 6-7.1-12-72(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the Counry Auditor of the counry where the property is loca-
ted dunng the 12 months betore May i l o! the year the deduction is to be eNecti�a.
See �everse side (o� additional inshuctions and qualifications.
01 applicant (owner or contract buyer)
applicant the sole Ipgal
name on rewrd is ditter
ame of contrad seller
idre � nt� seller
or eqmtanie.nwner±
c.l--
KI Yes ❑ No
exact
P1AY 12 1991
GIBSON
I with someone other than spouse,
with whom
Is 2ppliCant bluttl as tlefinCtl in IG 72-1-7-7 (n) antl IG 6-1.7-12-12(b)? Is appliCant disZblEd and unable to engage in any subst3nGal gainful aCtivil
as de5ned m IC 6-1.1-12(d)? ❑ yes ❑ No
Yes ❑ No
Is the properry used and occupied primarily,for his/hei residence? Does the applicanYs ta�cable gross income for the preceding calendar year
� � exceed $17,000?
L�Yes O No ❑ Yes ❑ No
T� district Key number / Legal description Record number Page number
' ,��. ��o� -QI Sos-c� j
I e certify under penalty of perjury that ihe 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, 79 _