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�`•°'�a APPLICATION FOR BLIND OR DISABLED PERSON'S COUNiY TOWNSHIP � YEAR -
; ... . } DEDUCTION FROM ASSESSED VALUATION �i J. `/\A ' — I �J
� Siate Fortn 43770 (R4 / 70-01)
�' �: � Presaibed by ihe Department ol local Govemment Finance '�
�ation contained in this dowment is CONFIDENTIAL pursuant to IC 12-1-1-7(n) and IC 6-7.1-12-12(b). File Mark
RUCTIONS:
To be filed in person or by mail with the County Auditor of fhe county where the property is located.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 0l the year the deduction is to be eflective.
2) Mobile Homes assessed�nder IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deducfion is to be effective.
See ieverse side for additional instructions and qualifications.
or
Is applipnt [he sole legal or equitlnle owner?
es ❑ �
It name on record is difterent than that of applic
No, what is
a�- Z�- �y_
id seller
as defined in IC 12-1-7-1(n) and IC .-12-72(b)?
❑ Yes o
ed and occupied prim '(or his/her residence?
Yes ❑ No
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MAY
exact share of interest? If owned with �meone other
indicate with �vhom /
�p� 006 ia� ao
as
exceed
I Is the property in question:
eal Property ❑ Mobile Home
t disabled and unable to engage in any substantial gai
in IC 61.1-12(d)?
es ❑ No
pplicanPs taxable gross inwme for the preceding calerv
❑ Yes ,��✓No
number Page number
61.1-�
year
I/We certify under penalty of perjury that the above and foregoing information is true and wrrect and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
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of auNOrized representative
Atldress of
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