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Disabilty_Etolen��; 1%' �,,,,� APPLICATION FOR BLIND OR County a �: '4,� 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 Is applicant the sole equitable ner? es ❑ no name on contract or IIf no, what is his/her exact interest? Is applicant blind as defined in IC IC 6-1.1-12-12(b)? � yes � no indicate below: Is the property used and occupied primarily for his/her residenc . yes � no Taxing District Key � .� -. Township Year (�� _ I ���ile MaF�i� J�.� �A � DEC 1 1 1992 W� nii�Tn�R 0"'s it ownea wi�n someone otnei spouse, indicate with whom. Is the applicant tlisabletl antl unable to engage in any substantial gainful activity as defined in IC 6-1.1-12-(d)? yes � no Does the applicanYs taxable gross income for the preceding calendar year exceed $13,000? � yes � no I� Page No. I/We certify under penalty of perjury that the aboS� and foregoing information is true and correct and that the applicant was a resident of Indiana and owner of the aforementioned property on March 7, 19 . �i � � Authorized Representative (by executed Power of Attorney)