Disability_Ricketts M-ct APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
a1 1. DEDUCTION FROM ASSESSED VALUATION
4\7 i' State Form 43710(R13/1-20) G t\D_ 1 k rt t'on e.y ��
Prescribed by the Department of Local Government Finance 50)..,
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
C h ecc\ L. i; c1-e-1-
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:
es ❑ 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:
[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 ❑ 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?
L.Ixes ❑ No ❑ Yes L_ o
Taxing district Key number/Legal description Record number(contract) Page number(contract)
At0 fix Is- oiv\e-r-`- 0r?6-17-3(-aoO-o00. P64-oil
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)
(/��kedtieell (///{7 -' _ 11488 W 1000 5 0 w ..es.,•.\\€ �.AiLf 7 C0(
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name of applicant Date filed(month,day year)
C.1,-ke_co-- L ?: (--`4.--e-sc ks FILED
Name of contract seller
O C T 4 2022
Taxing district
> aC9-(1-31- 2oo -000, 2 (0&/ - oil yh
Key number/legal description GIBSON COUNTY AUDITOR
AoYN i-goln e,,--,)
Signature of County Auditor Date signed(month,day,year)
J Ab a q.A✓ 47 10/L/
Notice of Award
0000167 00019529 2 SP 0.810 0913M3MCS4PI T125 P
CHERAL L RICKE 1'Ib
k -: 11488 W 1000 S
POSEYVILLE, IN 47633-9612