HomeMy WebLinkAboutDisabilty_Shelton°°' APPLICATION FOR BLIND OR DISABLED PERSON'S
r. t DEDUCTION FROM ASSESSED VALUATION
�� State Fwm 43710 (R / 9-96)
�` � Prescribed by ihe State Board of Taz Commissioners
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In�tion contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-7 (n) and IC 6-1.1-12-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the property is loca�
ted during the 12 months be%re May i l ol the year the deduction is to be eflective.
See reverse side lor additional instructions and quali�ications.
contract
applicant the sole legal or equitabie owner?
�s ❑No
nameon
conuaa
of contract seiter
If No, what is his/her exad
COUNTY TOWNSHIP YEAR
ile k
_. A_ A
FEB 19 1997 �
tl owned with someone other than spouse,
indicate with whom
appllcant blintl as tletinetl in IG 12-1-1-t(n) antl IG 6-1.1-12-12(b)? Is applicant disabled and unable to engage in any substantial gainful acGvi
1 / as defined in IC 6-1.1-12(d)? es ❑ NO
❑ Yes � No
the property used and oxupied primarity. for his/he� residence? Does the applicanYS taxable gross income for the preceding calendar year
exceed $17,000?
❑Yes ❑NO ❑Yes ❑No
xing distria Key qtlmpe�r / L�qal�Qscri�tio �1 Record number Page number
(.,CJ (o—(A �v �.t�
,.� r -; - .
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent oi Indiana and owner'of the a(orementioned property on March 1, 19 _
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