HomeMy WebLinkAboutDisabilty_CanslerAPPLICATION FOR BLIND OR DISABLED PERSON'S courm� OWNSHIP r�
. -- DEDUCTION FROM ASSESSED VALUATION
� � � Sfam Form 43710IR9/9-08)
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'PrasrnbeE by ttie DepartmeM d Lod Grnerturenl F(unce
�nformation contained in this doaiment is CONFIDENTIAL pursuani b IC 6-1.1-12-12(b). F,{�pti Mark
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IIWe certify under penalty of perjury lhat lhe above and foregoing infortnation is We and coaecl and IhatLie applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20
of appbam
W auUwrized mpresen�ative
Pddmss o� applipM (imnDM aM sbre4 my, statr:. and LP mdc)
AGErassolaulhorizsCrepeSenWive (numDpandsbecf.cRy,sfafe.andLProde)
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