Disabilty_Dishon (2) .M�^��.a,,, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
,�. "a DEDUCTION FROM ASSESSED VALUATION
afI' State Form 43710(R13/1-20) (/1^ `yam
;e ✓' Prescribed by the Department of Local Government Finance v 1 Jjuh W1 nLe_+Q^ (:: a
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.
Name of applicant(owner or contract buyer)
• 1N() v -e__J11 -1 .1 .s\r- all-
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----
on`trac�t seller
I
Address of contract seller(number and street,city,state,and ZIP code) Is thperty in question:
ff-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 ( 11 E 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?
Yes ❑ No ❑ Yes LJ rvo
Taxing district Key number/Legal description Record number(contract) Page number(contract)
p,-. ,c_,+,) n D La - 1 I-1-a - D 014- 0( ^7 L-17 -- 0 , c3"-'
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of plicant Address of applicant (number and street,city,state,and ZIP code)
eirg /�) 1a SIk) rP. "t:0 _-
„gnature of authorized representative Address of authorized representative (number and street,city,state and ZIP code) 1
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day year)
VICLikAre -15) Ir,Cr, • FILED
Name of contract seller
'— \ • G• � 4, Zz-(?ZZ
Taxing district
Pr.\ NC `thy a.
Key number/legal description GIBSON COUNTY AUDITOR
ate - \.\-ka-a0\-\- owl . --)\-\-► - ODR -
Signature of County Auditor Date signed(month,day,year)
��sEC4
yiV.SOCIAL SECURITY ADMINISTRATION
VI?Il o Office of Hearings Operations
srnr�� Old Post Ofc, 3rd Fl
100 N.W. Second St.
Evansville, IN 47708-9923
Date: December 16, 2022
Karen Dishon
123 N Center St
Princeton, IN 47670
Notice of Decision - Partially Favorable
I carefully reviewed the facts of your case and made the enclosed partially favorable decision.
Please read this notice and my decision.
Another office will process my decision. That office may ask you for more information. If you
do not hear anything within 60 days of the date of this notice, please contact your local office.
The contact information for your local office is at the end of this notice.
If You Disagree With My Decision
If you disagree with my decision, you may file an appeal with the Appeals Council.
How To File An Appeal
To file an appeal you or your representative must ask in writing that the Appeals Council review
my decision. The preferred method for filing your appeal is by using our secure online process
available at https://www.ssa.gov/benefits/disability/appeal.html.
You may also use our Request for Review form (HA-520) or write a letter. The form is available
at https://www.ssa.gov/forms/ha-520.htm1. Please write the Social Security number associated
with this case on any appeal you file. You may call (800) 772-1213 with questions.
Please send your request to:
Appeals Council
5107 Leesburg Pike
Falls Church, VA 22041-3255
A
1
1 Form HA-L76-OPI (03-2010)
Suspect Social Security Fraud?
Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline
at 1-800-269-0271 (TTY 1-866-501-2101).
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