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