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�,,,,� APPLICATION FOR BLIND OR
a`' °.q 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.
Applicant (Owner or contract buye
Is applican e sole legal or f no, wh
equita owner? interest?
yes � no
If name on re or fferent tha t t of ap '
Name of contract seller:
Address of contract seller:
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Ic onnlir�nt hlin oe riafinori in IC 19_t.t.t/r
6-1.1-12-1 b)?
� yes � no
the g/operty used and occupied primarily for his/her
yes � no
County
r
Township � Year
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��P1813 �994
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AUDITOR
If oWned with someone other than
spouse, indicate with whom.
�rtt disabled and unable to engage in any
gainful activity as defined in IC 6-1.1-12-(d)?
� no
Does the applicanYs tax bte gross income for the
preceding calendar ar exceed $13,000?
� yes no
y ^T,� , ���'a(��� O Page No.
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I/We certify under penalty of perjury that the above and foregoing information is true n correct and that the applicant
was a resident ot Indiana and owner of the aforementioned property on March 1, 19�.
Authorized Representative (by executed Power of
Attorney)
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