Disabilty_Thaxton • �s APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
4 ' DEDUCTION FROM ASSESSED VALUATION TQ,A
11 ^/i' State Form 43710(R13/1-20) O / .6 �Z�Prescribed by the Department of Local Government Finance CC��
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 Dec r 31 and filed or rked by the
<---------� -\-\ cX\--0iN 1k '30 [20 2z..
Is applicant the sole\egal or equitable owner? If No.what is his/her exact share of interest? If owned with s�nt;On■ot r thansp
Xes
indicate with w ( 1L❑ No
If name on record is different than tapplicant,indicate below: N O V 3 0 2022
fraiLnal
Name of contract seller net-- a P
GIBSON COUNTY AUDITOR
Address of contract seller(number and street,city,state,and ZIP code) Is h property in question.
Real 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 unab e to gage 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? Do exceed$17 applicant's
lica is taxable gross income for the preceding cal dar ear
Yes ❑ No ❑ Yes i No
Taxing district Key nu er Legal description Record number(contract) Page number(cart act)
�2 26 -11)-21-1-202-000 .C6(1-02S-)
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
sob s- — pt- 1 (1, - 3\c) .
at of authorized representative —„__— Address of authorized representative (number agb street,city,state,and ZIP code)
Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Award
Mid-Atlantic Program Service Center
300 Spring Garden Street
Philadelphia, Pennsylvania 19123-2992
Date: July 26, 2022
BNC#: 22MS959K27887-HA
,IIIIuutIIIIIIIIIIuI.IIIIIIIIIIIIIuIIIIIIIIIII111'IIII'111III1u11 0
0000428 00006363 2 SP 0.810 0722M3MCS2PI T45 P c
JOSEPH E THAXTON :2;n 506 S MAIN ST
FORT BRANCH, IN 47648-1516
op,SE et,�
A, � Social Security Administration
Ilion e Benefit Verification Letter
Tetiv
a"
n
m°
c
llniIIIIIIIII.IIPIuuiuinIIIuII,IIiIIIIIIIIIIII.Innuurilli i�
JOSEPH E THAXTON b2
506 S MAIN ST g
s FORT BRANCH IN 47648-1516
"IN