Disabilty_Wildt, -,.
°�Aa APPLICATION FOR BLIND OR DISABLED PERSON'S
. , :! _ � -DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (R / 9-96)
,� �� Presaibed by the Stata Baard af Taz Commissioners
Information contained in this documem is CONFIDENTIAL pursuant ro IC 12-1-7-1(n) and IC 6-1.7-12-72(b).
INSTRUCTIONS FOR FILING:
To be liled in person cr by mail with the County Audi[or ol the county where the property is loca-
ted during the 12 months belore May 11 0l the year the deduction is to be el%ctive.
See reverse side for additional instructions and qualifications.
Name of applicant (owne� or
hisfier exact share of interest?
• BC`�� ''.
���
1 = � ` "I'r
k s
in IC 61.1-72(d)?
gross
DEC 3 0 1999
I with someone oiher
with whom
❑ Yes
spouse,
❑ No
year
I/We certify under penalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a resi-
dent of Indiana and owner of ihe aforementioned property on March 1, 19 � '
authorized
�