HomeMy WebLinkAboutDisabilty_Byrne�t
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r• APPLICATION FOR BLIND OR _
a`'���'�0,� DISABLED PERSON'S DEDUCTION
_� . , FROM ASSESSED VALUATION
�.'• ,.,� ,,'i State Form 43710(
exceed $13,000?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicar.t
was a resident of Indiana and owner of the aforementioned property on March t, 19 .
Signature
Authorized Representative (by executed Power of
Attorney)
Address of Representative