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APPLICATION FOR BLIND OR DISABLED PERSON'S
OEDUCTION FROM ASSESSED VA�UATION
Sfate Form 43710 (R7 / 5-06)
Presaibcd by tt�e Depvimmt W Lo�l Govemmeni Finance
COUNTY TOWNSHIP YEAR
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�nfortnation contafned in this documen� is CONFlDENTIAL pursuant to IC 12-7-7-1(n) and IC 6-1.b72-72(b�. File Matk
iNSTRUCTIONS- AUG I L [O�b
To be filed in person or by mail with fhe County Auditor o7lhe county where the property is located. ._,
Fi/ing Dates: 1) Real Property: During the 12 months before June 11 of [he yea� the deduction is to b �
2) Mobile Homes assessed under IC 6-1. 1-7: Du�ng the 12 months betore March���� ��,e AUDI OR W�shes to
obtain the deduction.
See reverse side for additional instructio
Name of applicani (�wner or contract buyer)
applicaN the sole legal or equitable owneR
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name on record is difterent lhan'that ot appficant, indicate
ame of conVacf sellgr
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idress of conVact seller
applicani blind as defined in IC 72-1-1-1(n) and IC 6-1.1-1
❑ Yes
P�oPertY
his/her residence?
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exact share of interest?
Is applicant disabled and
as defined in IC 6-7.1-12-
Key number / Legal description
a�-� �-+4-aa -�i3
It owned with someone other than spouse,
indicate with whom
Is Ihe property in questlon:
❑ Real Property ❑ Mobile Home (IC 61.
engage in any substanfial gainWl activiry
❑ Yes ❑ No
taxable gross income for fhe preceding calendar year
❑ Yes ❑ No
Rewrd number Paqe number
I/We certify under penalty of pAc/ury that the above and foregoing infortnation is Irue and correct and that the applicant was a residenf
of Indiana and owner of the aforementioned property on March 1, 20 _
�-�� � p I Address of auNorized
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