Disabilty_Buck ��_R•*•�, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
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:. ._- DEDUCTION FROM ASSESSED VALUATION
" i State Form 43710(R13/1-20) r A
f�/� 23
° '' Prescribed by the Department of Local Government Finance l7 Son aC
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) ` `
\3 A.Zu04\
Is applicant the sole legs or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
,--,// indicate with whom:
1res ❑ No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
[r iTeal 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)?
LVes ❑ 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?
2 Yes ❑ No 11-Yes ❑ No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Mc..r.lt>Gy ao ,Po-1y- (U3-cxo. o(¢ y^boa
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
tureobapplicarfic' . . . Address of applicant (number and street,city,state,and ZIP code)
Wail/ c &AC, 6ii.P -5 "b;\isf\ark_ S t-. 00, ,la.Ac4 Cd-i.TA/ er7G6o
Signature of a norized representative Address of authorized representative (number and street,city,state,and ZIP code) J 1
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
W o``Sle. A 3v C IL
Name of contract seller
Taxing district IF'Ii i
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/00'`v_v APR 24 2023
Key number/legal escription
Qc —?o-14-' 103—Ce6. o0lit- 00 e.ara
Signature of County AuditorAuuditorr ( 7fitEEDVers d$Hi'�lajAOITOR
ALL.
ejto.....,
Ink
Notice of Award
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0000126 00013692 2 SP 0.810 1221M3MCS4PI T96 P
aiim WAYNE A BUCK
6942 S DIVISION ST E
OAKLAND CITY, IN 47660-7726
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