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Disabilty_Saylor� APPLICATION FOR BLIND OR �, .,...o e .�. � 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 or 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. ;��� 2 ? 1996 � �0�� Appli (Owner or ntra t buyer) Is applic t the le legal If no, what is his/her exact share of If owned with someone other than equitable owner? interest? spouse, indicate with whom. �j yes � no 7� If name on record different than that of applicant, indicate below: Name of contract seller: Address of contract seller: Is applicant blind as defined in IC 12-1-1-1(n) & Is the applicant disabled and unable to engage in any IC 6-1.1-12-12(b)? substantial gainful activity as defined in IC 6-1.1-12-(d)? � yes � no � yes � no Is the property used and occupied primarily for his/her poes the applicanYs taxable gross income for the residence? preceding calendar year exceed $13,000? � yes � no � yes � no Taxing District Key NumberlLegal Description Record No. � ___�,)� 90(� - �ol7a� \l.Q.le-w!,-eJ - 50 • 098� � C Page No. ' -I I/We 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 Signatu Authorized Representative (by executed Power of Attorney) , ddr s of App ant Address of Representative �.2. % /:�2� �EV �— �,