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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fofm 43710 (Rd ! 70-0i)
Prescnbed by Ne DeDartment of Local Govemment Finance
COUNTY TOWNSHIP YEAR
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In! rmation contained in this document is CONFIDENTIAL pursuant to IC 12-7-74(n) and IC 6-1.1-72-12(b). ' i�Ma�
�RUCTIONS:
� e �led in person or by mail with the County Audito� of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 1 i of the year the deducfion is to be ef/ectiv � AN
2) Mobile Homes assessedLnder IC 6-1.1-7: Between January 15 and March 31 0l the ye�e dedu�
See ieverse side for additional ins(ructions and qualificafions.
or equitabl/e oy�ner? I If No, what is
L�l'es ❑ No
It name on record is diYerent than that of
Name of contract seller
as
the property
W „
(n) and IC 6-1.7-72-12(b)?
� Yes ❑ No
ii ownetl with someone
indicate with whom
2 9 2002
Is the property in question:
6e
spouse,
❑ Real Property ❑ Mobile Home pC Et.
Is applicant disabled and unable to engage in any subs ntial gaintul aaivi
as defined in IC G7.1-12(d)?
es ❑ No
and ocwpied pri rity for his/t�er residence? Dces the applicant's taxable gross income for the preceding calen r year
exceed 517,000?
Yes ❑ No ❑ Yes o
Key number / Legal desaiption Record number Page number
INVe ceRify under penalty of peryury that the above and foregoing infortnation is true and correct and ihat the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
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