HomeMy WebLinkAboutDisabilty_Hunt�°'°'"v APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Form 43710 (R / 9�96)
�,� �� Prescnbetl Oy Ne Sute Boartl ol Taz Commissioners
Inrormatlon contained in this document is CONFIDENTIAL pursuant to IC 12-7-7-7(n) and IC 6-1.7-72-72(b).
INSTRUCTIONS FOR FILING:
To be /iled in person cr by mail with the CountyAuditor of the couniy where the property is
ted during the 72 months be(ore May 11 0/ the year the deduction is to be eflective.
See reverse side (or additional instructions and qualifications.
applicant the sp� legal or
v es ❑ No
name on rewrd is diHerent than that of applicant, indicate below
Name of contrad se
�
�
Address of contract
Is applicant blind as
I5 the properry used
�
Tazing districll
in IC 12-7-1-1(n) and IC -1.1-72-1
❑ Yes �
�
❑ No
exact
COUNTY TOWNSHIP YEAR
�-.-�„
� �;" ?+" �#j �: -�
� �! I
_ . _ ... .-..�le
f�AY 0 8 2000
I wfih someone
witn whom
to engage iKany su
❑ Yes
than spouse,
❑ No
activiry
Does the applicant's taxable gross income for the preceding calendar year
exceed $7 7.000? ���
❑ Yes �-U�IVo
� -�0`� 35-C�
Record number I Page number
IIVJe ceAity under penaity of perjury that the above and (oregoing intormation is true and correct and that the applicant was a resi-
dent of Indiana and owner ot the aforementioned property on March 1, 19 �
of appliwnt
7U
ezecuted Power olAttomey)