HomeMy WebLinkAboutDisabilty_Whitehouse- ; �:.
�,,,,� APPLICATION FOR BLIND OR
a`'..: °� DISABLED PERSON'S DEDUCTION County Township Year
. 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.
or ontr� act buyer)
de leaa�� I
equitable owner?
� yes ❑ no
It name on record di
seller:
Address of contract seller:
Is applicant blind as
IC 6-1.1-12-12(b)?
� yes � no
interest?
than that of applicant, indicate below:
Is the property used and occupied primarily for his/her
res�nce?
yes � no
Taxing District Key NumberlLegal
r r
of
APR 2 � 1995
(�Gv�nz� � . /y�e�-�
ni inirna
If owned with someone othe
spouse, indicate with whom.
Is the applicant disabled and unable to engage in any
s�antial gainful activity as defined in IC 6-1.1-12-(d)?
yes � no
Does the appiicant's taxable gross income for the
preceding calendar year exceed $13,000?
� yes f7.h no
��„
• •
I/VJe 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
Signature I Authorized Representative (by executed Power of
/� /J , Attorney)