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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fortn C3710 (R / 9-96)
Presaibed by ihe State Boartl ol Ta< Commissioners
I nGon conlained in this dxument is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.7-12-12(b).
l UCTIONS FOR FILING:
To be liled in person or by mail with the Counry Audrtor ol the county where the property is loca-
ted during the 72 months belore May i l ol the year the deduction is to be e/fective.
See reverse side lor additional instructions and qualilications.
or
urres ❑ No
No, what is his/her exacl share
name on record is different than that of applicant, indicate below
contrea
Is appiicant blind as defined in IC 12-1-1-1(n) and IC 6-1.7-72-12(b)?
❑ Yes `d'No
L7 Yes ❑ No
�distria �Nw �_2,// , (oS9
P�a
COUNTY TOWNSHIP YEAR
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File Mark �
�Y 11 1998
�
i-.�c.�.�� �.,/-�
C__ .,,,. . ..
I wlth SOmeOnB othef thdn Sp0u58,
with whom
is appucant tllsabled antl unable to engage in any substanual gainful
as defined in IC 61.1-12(d)? [�S ❑ No
taxable gross income for the preceding
Record number
❑ Yes LyNo
year
I/We certify under penalty of perjury that the above and foregoing iniormation is true and correct and that the applicant was a resi-
dent of Indiana and owner'of the aforementioned property on March t, 19 _
of authorized representative
i �
of authorized representative
(li�ti����� �L76>d