Disabilty_Williamson .0fnhe. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
�' ''- DEDUCTION FROM ASSESSED VALUATION
Z - ;'-" State Form 43710(R13/1-20)
'y;me�v' Prescribed by the Department of Local Government Finance P b„y, lakuoi 2o
File Mark
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 and signed by December 31 and filed or postmarked by the following January 5 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 contract buyer)
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Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑ Yes III No
If name on record is different than that of applicant,indicate below:
lithat 4101 MAfida jf 1 6O(m�
Name of contract seller
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Address of contract seller(number and street,city,state,and ZIPcode) ISth proerty in question:
7DD ►, / OkJ6tJAcQ/"( /7(_� L ,Real Property ❑ AnnuallyViJ h/ l/�/�l/+'O ,T 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 6-1.1-12-11(d)?
❑ Yes ❑ No Yes ❑ No
Is the property used and occupied primarily for his/her residence?
Page number(contract)
W7 .1441j1-- --/9'ie.' 0ilt— . 535-0a40
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)
11)1 f•cxl f vvne (dlf., AS\rtf7/oF
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
SUS 44 WSOM FILED
Name of contract seller
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Watt Mit/Ail da J / ' I ) SEP 2 9 2020
Taxing di trict ww e /
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Key number/legal description GIBSON COUNTY A TOR
14—lq^jg—30 -. awe. 535- a a .0
Signature of County Auditor Date signed(month,day,year)
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