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d��,,,no APPLICATION FOR BLIND OR County
� DISABLED PERSON'S DEDUCTION
�� '. ; FROM ASSESSED VALUATION
.,. 1e„ ;; 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
or � IYno, what is his/her exact
eqwt e owner? interest?
�yes � no
name on
Address of contract seller:
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.
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Township Year
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ile��
MAY 0 y �gg�
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ir ownea witn someone otnei
spouse, indicate with whom.
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Is applicant blind as defined in IC 12-1-t-1 n) & Is the applicant disa led and unable to en age in any
IC 6-1.1-12-12(b)? subst tial gainful activity as defined in IC 6-1.1-12-(d)?
� yes � no [✓✓�yes � �po
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Is the property used and occupied primarily for his/her poes the applic� � �
residen . preceding calen� �' ��
yes � no � YeS .�f �.,_ �L�—%.� ����"/�
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P�-�� . � a�- � -9�
I/We certify under penalty of perjury that the above and foregoing inf rr
was a resident of Indiana and owner of the aforementioned property on
Signature
� �C
ss of Applicant
Authorized
Attorney)
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