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Disabilty_Reeder �, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
s° ".t DEDUCTION FROM ASSESSED VALUATION � � �
State Form 43710(R13/1-20) 6 t h
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.
l�enne/A L l�-e,ec%r-
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:
E'res ❑ 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 p perry in question:
eal Property El 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)?
❑ No es El 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? Kr-
Yes ❑ No CI Yes !r No
the above and foregoing information is true and correct.
Signa ure of applicant Address of applicant (number and street,city,state,and ZIP code)
Soo J1/4) 1A k��
Sig ature of authorized repres tative 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)
tnne �, ����� FILED
Name of contract seller
Taxing district SEP 3-0 202Z
Key number/legal description GIBSON COUNTY AUDITOR
&-(1-(g- 30( - Co37 —baG
Signature of County Auditor Date signed(month,day,year)
/ [/
c
Kenneth Eugene Reeder
500 N. Willard St_
Fort Branch, TN 47648
Notice of Decision — Fully Favorable