Disabilty_Gates •
�^ ,, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
di DEDUCTION FROM ASSESSED VALUATION
5��• l' State Form 43710(R13/1-20) \
Prescribed by the Department of Local Government Finance 1so o -
0 04-
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
Name of pplicant(owner or contract buyer) .
Is applicant the sole legal-quitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑ Yes ❑ No •
If name on record is different than that of applicant,indicate below:
FILED
Name of contract seller
DEC 1 4 2022
Address of contract seller(number and street,city,state,and ZIP code) / th roperty in question:
�y7_ ( a .t,f,-_,[ ned Real Property ❑ Annually Assessed
/,Lcc' NTYvruD�luTOR Mobile Home(IC 6-1.1-7)
CIBSON COU SU
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 Ao )(Yes ❑ No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding cale dar ear
exceed$17,000?
Aces 1::] No El Yes No
Taxing district Key n be /Legal description Record number(contract) Page number( nt ct)
0 0 1— %Y'N—t8-Lot - oo0. 364- - 001- .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
nature of a plicant 1:0C 110.1 Address of applicant (number and street,city,state,and ZIP code)
•
•
1)('
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
Notice of Award
8
0
0.0
0
0000085 00019157 2 SP 0.810 1125M3MCS6P1 'I'126 P
LEE E GATES
431 NORTH LINCOLN AVE• o
OAKLAND CITY, IN 47660-1327
:
Pub 05-10153
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