Disabilty_SchatzAPPLICATION FOR BLIND OR
r•°'°o County Township Year
d,�>. a DISABLED PERSON'S DEDUCTION
"�' i= 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.
Applicant (Owner or contract
Is applicant the sole legal or
equitable owner?
� yes � no
name on
contract
Address of contract seller:
Is applicant blind as defined in
IC 6-1.1-72-12(b)?
� yes � no
If nd, what is
interest?
12-1-1-1(n) &
Is the property used and occupied primarily for his/her
residence?
j�yes � no
r-•
axing District
,�� ,� ��
File Mark
of w ne other than
o s ind it whom.
Is the applicant disabled and unable to engage in any
substantial gainful activity as defined in IC 6-1.7-12-(d)?
� yes � no
Does the applicanYs taxable gross income for the
preceding calen ar r exceed $13,000?
� yes no
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
was a resident of Indiana and owner of the aforementioned property on March 1, 19 .
Signature I Authorized Representative (by executed Power of
, _ �, n n . Attorney)
Address of Representative