Disabilty_Bullington c
y APPLICATION FOR BLIND OR DISABLED PERSONS COUNTY TOWNSHIP YEAR
`,t DEDUCTION FROM ASSESSED VALUATION i.. State Form 43710(R13/1-20) �2 I r' Prescribed by the Department of Local Government Finance O
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
Name of applicant(owner or contract bu er , I ^
Is applicant the s le legal or uit ble owner? IC .what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑ Yes [I] No FILED
If name on record is different than that oapplicant,indicate below:
Name of c tracts Ile 01.-.--)
DEC 1 3 2022
,- �ti. >,..)
Address of contract s-Iler .- 10- -nd street,city,state,and ZIP cod Is h property in question:
IBSON COUNTY AUDITOR AnnuallyAssessed
Real Property El
Mobile Home(IC 6-1.1-7)
Is applicant blind as de - 12-7-2-21(1)? Is applicant disabled and unab e to en age in any substantial gainful activity
No
as defined in IC 6-1.1-12-11(d)?
❑ Yes L,d Yes ❑ No
Is the property used and occupied primarily for his/her residence? ��eed$1 70100?is taxable gross income for the preceding caler�C/ar�U'ear
es ❑ No ❑ Yes KN.:
Taxing district Key number/Legal description Record number(contract) Page number(c
Z� 2 -12-0l—�i�3- 001-� -028 .
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)
Signature of authorized representative Address of authorized representative (numbei•"and street,city,state,and ZIP code)
n
J
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N
rd
TAMMY DAWNELLE BULLINGTON
706 S SEMINARY ST N
PRINCETON IN 47670-2632
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