HomeMy WebLinkAboutDisabilty_Weiss 0,---kg. APPLICATION FOR BLIND OR DISABLED PERSON'S s COUNTY ' IuvowaHIP YEAR
/_-�i; DEDUCTION FROM ASSESSED VALUATION
k!.." State Form 43710(R13/1-20) Gson 009 2020
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,,1e if Prescribed by the Department of Local Government Finance
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)
Weiss, James E
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:
IIYes ❑ No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
0 Real Property ❑Annually Assessed
Mobile 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)?
❑ Yes 0 No ® Yes ❑ 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?
0 Yes ❑ No • ❑ Yes 0 No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
009 26-18-36-403-000.067-009
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sii tur of applicant Address of applicant (number and street,city,state,and ZIP code)
,, g, 113 S Vonna Lane, Haub, IN 47639
Si nat( of authorized re resents've Address of authorized representative (number and street,city,state,and ZIP code)
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RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
Weiss, James E
Name of contract sellerF I 1i
E I_Di
Taxing district
DEC 2 2 2020
009
Key number/legal description 1/ i Vr
26-18-36-403-000.067-009 GIBBON COUNTY AU II ITOR
Signatur f C unty Auditor Sns Date signed(month,day,year) n
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