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HomeMy WebLinkAboutDisabilty_Bottoms • • .•'• APPLICATION FOR BLIND OR DISAB ERSON'S fOUNTY TOWNSHIP YEAR •• '% DEDUCTION FROM ASSESSED V ATIONf� r1 5�.. State Form the (R13/1-20)• vim, ` I,S - _,./'� /'�© �J/1'/ 2 ,a1� Prescribed by the Department of Local Government Fie 4 r I W V t V J (��La- -. 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 wh a property is located. Fling Date: Form must be completed and signed by December Name of ap licant(owner or contract yer) c:/v &It. _ JOo� Is applicant t e le legal or equitabl owne ,what is his/her exact share of interest? If o wJ s eonE t al .use, indi to wi w m: Yes ❑ No 2 If name on record is different than at f applicant,indicate below: -LJU�/L 9 �2022L Name of contract seller 7)�+ C C�.Jik4.Y•'.r GIBSON COUNTY AUDITOR Address of contract seller(number and street,city,state,and ZIP code) Is a erty in question: Real Property ❑ 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 6-1.1-12-11(d)? X ❑ Yeso Yes ❑ No Is the property used and occupied primarily for his/her residence? �// �` Does the applicant's taxable gross income for the preceding cal ddar ear exceed$17.000? Xo es ❑ No ❑ Yes Taxing district Key nu be /Legal description Record number(contract) Page number( 26-13--f-303- bock 066- 003"--- I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant A ress oQf ap licant n tuber and street,city,state,and ZIP code) o of au 6_ Zci K �dn d s ^ 3n— L -6 k9 re horized representative Address of authorized representative (number and street.city,Iate,and ZIP code) • SEC, -��SOCIAL SECURITY ADMINISTRATION USA 4i�11f111��02 Joan Bottoms .