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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Form 43710 (R4 / 10-01)
Prescribed by Ne Department of Loral Govemment Finance
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�^F^rmation contained in this document is CONFIDENTIAL pursuant to IC 12-1-7-7(n) and IC 6-1.1-12-12(b). �e�
�aucr�oNS: MAR 3 1 2003
o be (led in person or by mail with the County Audito� o/ the county where the property is located.
Frling Dates: 1) Real Property: Dunng the 12 months before May 17 0l the year the deduction is to b flective. �
2) Mobile Homes assessedLnder IC 6-1.1-7: Behveen January 15 and Maich 31 o/the ttie ��d+���_'IS,to be�neffe ive.
See reverse side for additional instructions and qualifications.
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Name of applicant (Qwnerorconhact
❑ No
name on
contract
Address of wntrad seller
blind as defined in IC 72-7-1-i
❑ Yes ❑ No
❑ No
disVict
ezact
indicate below
If ownetl with someone
indicate with whom
the property in Question:
as defined in IC 6-7.7-12(d)?
Does the applicant's taxable gross
exceed 577.000?
Key number / Legal desaiptlon
than spouse,
tl Property ❑ Mobile Home
engage in any subsWntial gain
❑ Yes ❑ No
for the preceding cal
❑ Yes ❑ No
number Page number
Cr7.1
year
I/We certify under penalry �f,�erjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
of
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