Disabilty_Patterson�.. . ,: -
��,,,,�o APPLICATION FOR BLIND OR
d � DISABLED PERSON'S DEDUCTION
�. , FROM ASSESSED VALUATION
�.,. ' .,• State Form 43710(1-90)
"" prescribed by the State Board of Tax Commissioners
Instructions for filing:
To be filed in person o� by mail with the County Auditor of the
county where the property is located during the 12 months before
May 11 of the year the deduction is to be effective. See reverse
for additional qualifications and instructions.
(Owner
Is applicant tl e sole
eqwtabl wner?
- yes � no
fiY•TilIZ�LI
contract
legal or
seller:
If no, what
interest?
Is applicant blind as defined in IC 72-1-1-1(n) &
IC 6-7.1-12-12(b)?
� yes � no
Is the property used and occupied primarily for his/her
residence?
es � no
District
�.� , � �
exact
%
r�UN 2 8 1993
C� .ti'.
If owned with someone othe
spouse, indicate with whom.
Is the applicant tlisabletl antl unable to engage in any
substan' gainful activity as defined in IC 6-t.t-12-(d)?
yes � no
Does the applicanfs taxable gross income for the
preceding calendar year exceed $13,000?
� yes �' no
. 1 C�-f"� I �,� - �3 -� - �o
3.�8 A C. I Page
I e certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant
was a resident of Indiana and owner of the aforementioned property on March 1, 19
Signatur� '
�
Authorized Representative (byexecuted Power of .
Attorney)
,�