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-� �APPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
State Form 43710 (R / 9-96)
�' �u � Prescribed by the State Board ot Tax Commissianers
Ir�ation contained in this document is CONFIDENTIAL pursuant to IC 12-1-7-1(n) and IC 6-7.1-12-72(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor of the aounry where the property is loca-
ted during the 12 months belore May 11 0! the year the deduction is to be e/%ctive.
See reverse side /or additional instructions and qualilications.
Name of applicant (owner or cronhact buyei)
�
Is applica the wle legal or equitable owner? If No,
Yes ❑ No
If name on record is difterem th that of appliwnt, indical
Name Of conVdIX Seller
Address of contraa selier
Is applicant blind as defined in IC 12-7-7-7(n) and IC 6-1.1
❑ Yes ❑ No
exact
COUNTY TOWNSNIP YEAR
��
File
AUG 1 51�`
I with someone
vrith whom
Is applicant disabled and unabte to engage in any s�
as defined in IC 6-1.1-12(d)? �yes
spouse,
❑ No
Is the property used and occupied primarily. for his/he� residence? Does the applicanYs taxable 9ross income for the preceding calendar year
exceed $77,000? �p
�s ❑ No ❑ Yes L?No
l�g district
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