Disabilty_Baehl Reset Form
APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
-Vie DEDUCTION FROM ASSESSED VALUATION
i)i) State Form 43710(R14/9-24) 2_ 6 .
1 'lie Prescribed bythe Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be filed in person or by mail with the county auditor of the county where the property is located.
Filing Date: Form must be completed, signed, and filed by January 15 of the
Name of Applicant (owner or contract buyer)
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Is applicant the sole legal or equitable owner? If No, what is his/her exact share or interest? 1 If owned with someone other than spouse, indicate with whom
les :i No
If name on record is different than that of applicant, indicate below:
Name of Contract Seller
Address of Contract Se er (number and street, city, state, and ZIP code) Is the Property in Question:
Assessed
Real Property AnnuallyMobile Home (IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)'7 Is applicant disabled and unable to engage in any substantial gainful activity as defined in IC 6-1.1-12-11(d)?
El Yes 4?"No ' es No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year exceed $17,000?
Epfir 71 No ❑ Yes
Taxing District Key Number / Legal Description Record Number(contract) Page Number(contract)
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Address of Applicant (number and street, city, state, and ZIP code)
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Sign ture of Authorized Representative Address of Authorized Representative (number and street, city, state, and IP code)
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RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND / DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
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FILED
Name of Contract Seller
Taxing District S E P 2 2 2025 rc,
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Key Number/ Legal Description (22‘ ./Za1,
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Signature of County Auditor Date Signed ( onth, day, year)
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EVANSVILLE, IN 47715
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