Disabilty_Carroll\
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APPLICATION FOR BLIND OR County
DISABLED PERSON'S DEDUCTION
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
equitable owner?
�yes � no
I( name on record di
contract
Is applicant blind as defined in
IC 6-1.1-72-72(b)?
� yes j�o
��
u no, wh
interest?
IC 12-1-1-1(n) &
Township � Year
�!QY 1 � 1995
�„�:� b' 1"y ,s
�� rrnrpR`�`r
it ownetl with someone othei
spouse, indicate with 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
Is the property used and occupied primarily for his/her poes the applicanYs taxable gross income for the
resi�d�{ ce? preceding ca`end^ar year exceed $13,000?
��yes � no � yes � ho
�-t �-t
Taxing District Key Number/Legal Description Record No.
DWe certify unde� 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 .
Authorized Representative (by executed Power of
Attorney)
Address, of Representative
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