HomeMy WebLinkAboutDisabilty_Lee .Y.-k APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
i • .
k DEDUCTION FROM ASSESSED VALUATION
t J: State Form 43710(R13/1-20)
Gibson Princeton 2023
",e„�✓' Prescribed by the Department of Local Government Finance
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,
below:
FILED
Name of contract seller
N/A APR 2 5 2023
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
�Z � ® Real Property ❑ Annually Assessed
GIBSON COUNTY AUDITOR 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 6r1No ®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?
lZ Yes ❑ No ❑Yes ® No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Princeton 26-12-08-301-001.590-028
I/VVe 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)
X 1:10 905 E Water St., Princeton, IN 47670
Signature of authorized represent,ive Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS •
Name of applicant Date filed(month,day,year)
John D Lee F 'LED
Name of contract seller
N/A APR 2 5 2023
Taxing district
Princeton Yh,eit a a)
Key number/legal description GIBSON COUNTY AUDITOR
26-12-08-301-001.590-028
Signature of County Auditor II ..��� (�1 Date signed(month,day,year)
MW0v1S -2
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Claim INtimer; .Jiu-54-11O811A
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JOIN o LEE Gf4 ,}
905 E WATER STREET -� —� � ` /
PRINCETON,IN 47670.224?
You are entitled to monthly disability benefits beginning July 2010.