Disabilty_Alvis - r _ I
,_ • APPLICATION FORBLINb OR DISABLED PERSON'S
f.
DEDUCTION FROM,ASSESSED VALUATION COUNTY TOWNSHIP YEAR
a+,, State Farm 43710(R1311.20)
�Sr Prescribed by the Department of Local Governs tri Finance
Iniomietlon contained In'Ihla deeument is CONFIDENTIAL:pursuant to IC c-1.1-35-9. File Mark
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 and signed by December 31'and tiled or postmarked by the.following January.S of the calendar year in which the
property taxes are first due and payable.
See reverse side for additional instructions and qualifications:
Name of applicant(owner or coated buyer)
Paul Michael Alvis
Is applicant the sole legal or equitable owner? If No,what Is blather exact share of interest? If owned with someone other than spouse,
Indicate with whom
IYes ❑No
If name on record Is diferent than that of!palcant,Indicate below:
Name of contract seller
N/A
Address of contract seller(number and street,dty,state,Ind ZIP code) Is the property in question:
N/A ®Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined In IC 12 7-2-21(1)? Is applicant disabled and unable to engage in any substantial gainful activity
as defined In IC s-1.1-12-11(d)?
❑Yes 21 No- 17.1 Yes ❑No
Is the property used end occupied pdmariy.for hisiher residence? Does the applicants taxable gross Income for the prededing calendar year
exceed S17,000?
®Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Princeton .26-12-07-403-000.041-028
IMIe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant(number end street.city,state,and ZIP code)
foul hi' G am" 612 S Prince St, Princeton, IN -47670 _
Signature of authorized representative Address of authorized representative(number and street,dty,state,and ZIP code)
RECEIPT FOR APPUCATION FOR.DEDUCTION FOR BLIND I DISABLED PERSONS
Name of applicant Date filed(month,day,year)
Paul Michael Alvis _
Name of contract seller
FILE
Taxing district
APR 15 2020
Princeton
Key number!legal description _ -
i
26-12-07-403-000.041-0 8I�11r.�
GIBSON COUNTY AUDITOR
Signs re of County Auditor • Date signed(month,day,year)
L_I 1._ _t._ , )Y`f\itt-11/4--) , Li— i —sz00(.4.1.