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HomeMy WebLinkAboutDisabilty_Nixon (2) APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR • 14 DEDUCTION FROM ASSESSED VALUATION �'t State Form 43710(R13/1-20) Gibson Oakland City 2022 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. 1 See reverse side for additional instructions and qualifications. Name of applicant(owner or contract buyer) Melvin Nixon Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? IIf o owne cn edwithwith wom one other than spouse, 0 Yes ❑ No If name on record is different than that of applicant,indicate below: Name of contract seller N/A 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)? Is applicant disabled and unable to engage in any substantial gainful activity as defined in IC 6-1.1-12-11(d)? ❑ Yes © No 0 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 El No El Yes 0No Taxing district Key number/Legal description Record number(contract) Page number(contract) Oakland City 26-14-19-102-000.769-007 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) ?1.1 OJ.trr.n) p` �p 114 E Trusler St., Oakland City, IN 47660 Signatute of authorized rrepr sen ative Address of authorized representative (number and street,city,state,and ZIP code) RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS Date filed(month,day,year) Name of applicant 141 TLF1D Melvin Nixon Name of contract seller N/A AUG 2 6 2022 Taxing district Oakland City r—ti .7/(r nd.) Key number/legal description GIBSON COUNTY AUDITOR 26-14-19-102-000.769-007 Date signed(month,day,year) Signature of County Auditor alp_zZ S ocial S ecurity Administration Retirement, Survivors and Disability Insurance Notice of Award Mid-America Program Service Center MELVIN R NIXON 114 E TRUSLER OAKLAND CITY, IN 47660-1834