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Disabilty_Woodruff r.,R,.•, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR lit.. ' DEDUCTION FROM ASSESSED VALUATION '\ State Form 43710(R13/1-20) '. Prescribed by the Department of Local Government Finance LStY' 1 0 /'Q C 7 2� • 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) /?5/ ;E )/rZIFp if owned with someone other than spouse, indicate with whom: leErY;IS ❑ No If name on record is different than that of applicant,indicate below: , eiUi3/11e A/�l, z Name of contract seller Address of contract seller(number and street,city,state,and ZIP code) Is the pr perty 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 S17,000? Yes ❑ No Yes ❑ No Taxing di lrict Key number I Legal description I Record number(contract) Page number(contract) 2-6—/z-29- C0—CV/— 6/5--62 7 I/We certify under penalty of perjury that the above and foregoing information is true and correct. Sign ur of applicant Address of applicant (number and street,city,state,and ZIP code) ' /0 /59© e , 256 L l/7Lo7J Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code) I • RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS Name of applicant Date filed(month,day,year) 01214/61;e drat Name of contract seller FILED Taxing dis MAR 142023 Key number/legal description i 47/ fL d C. ,JiY i /7 i210_ ) - iJ( - 1oo._ ^9V //5._62 GIBSON COUNTY AUDITOR Signature of County Auditor / F��7 t� Date signed(month,day,year) NO'SECG .. %SOCIAL SECURITY z 0 Ye ro Christie Woodruff 1390 East 350 S Princeton, IN 47670 Notice of Decision — Fully Favorable I I