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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Form 43770 (R4 / 70-0t)
Prescribetl by Ne Department of Local Govemment Finance
I �COUNTY TOWNSHIP YEAR
Rnation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-1� (b . e rk
i a
�RUCTIONS:
o be filed in person or 6y mail with the County Audito� of the county where the property is locat l� 2��2
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 of the year the deduction is�� Cef/ective.
2) Mobile Homes assessedunder IC 6-1.1-7: Behveen January 15 and MarchI3i� of the yea th educU is 6e ef/ective.
See 2verse side for additional instructions and qualifications. !� ^ g/
'� �.."TV e in F
Name of ap ' nt (owner or contract buyerJ "'-""'
� C -�
.
Is applicant th ole legal or equitable owner? If No, what is his/her exact share of interest? If owned witn someone other than spouse,
� � indicate with whom
name on record is diRei
�
ame of conirad seller
idress of contrad seller
appliqnt blind as defirt
the property used and c
� Yes ❑ No
than that of applicant, indicate below
❑ Yes ❑ No
❑ No
Is the property
❑ Real Praperty ❑ Mobile
3ble to engage in any subst�rtf
as defined in IC 6-1.1-12(d)?
Does the applicant's tazable gross
exceed 517,000?
QC 61.1-�
ful activiry
qy€s ❑ No
r the preceding calendar year
❑ Yes (/�Pt6
INle certify under penalty of perjury 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 _
F
�
of authorized representative