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��,,;,, APPLICATION FOR BLIND OR
� a` °�� DISABLED PERSON'S DEDUCTION
�. FROM ASSESSED VALUATION
�.,, !`; � State Form 43710(1-90)
"" Prescribed by the State Board of Tax Commissioners
�
Instructions tor filing;
To be filed in person or by mail with the County Auditor of ihe
county where the property is located during the 12 months betore
May 11 of the year ihe deduction is to be effective. See reverse
for additional qualifications and instructions.
App' ani r or ontrac
s E/��.�A
Is applicani the sole legal or
equitable owner?
(�yes ❑ no
If name on record diHerent tl
Name ot contract seller:
Address of contract seller:
Is applicant blind as defined
IC 6-i.t-12-12(b)?
�yes � no
If no, what is hislher exac; share of
interest?
12-1-7-1
County � Township � � Year
�5/Bso..� I /'.¢..��1
JUN 28 1996
�,n,„.� �'. d'
AUDtTOR
/S47
It owned with someone other than
spouse, indicate witi whom.
Is the appifcam dsab�etl antl unab�e to engage in any
substan' I gainful activity as defined in IC 6-t.t-12-(d)?
ye5 � no I
Is ihe property used and occupied primarily for his/her poes the applicanYs taxable gross in
reside e7 preceding calend year exceed S13
(�yes � no � yes �o
Tauing District Key NumberlLegal Description Record No.
�a,..rc.cTe,� 0�1�- 0.2 8P�- o� Pag�'No.
I/We certify under penalty of perjury that the above and foregoing in(ormation is true and correct and
was a resident of Indiana and owner of the atorementioned property on March t, �92�.
for the
the applicant
Sig ature Authorized Represeniative (by executed Power of
l ���� p � � � � Attomey)
��� ,d
Address of Appiicant � Address of Representative
S�."t �SReF���O fie,••�cere�..l .L� �
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