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Disabilty_Siekman (2) • APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR ;71.77'igt DEDUCTION FROM ASSESSED VALUATION tiftitS'il State Form 43710(R13/1-20) )15,, (1/4 x2-3 • Prescribed by the Department of Local Government Finance 30 Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark 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 Iv 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 instruc• s and qy.alifiations. Name of applicant(owner or ontr t buyer) Li ry ekir7 412_ 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: LED-R-651r-oi Duty El Annually Assessed Mobile Home(IC 6-1.1-7) Is applicant blind as defined in IC 12-7-2-21(1)7 Is applicant disabled and unable to engage in any substantial gainful activity defined in IC 6-1.1-12-11(d)? D Yes L.,...2-1re-sLI 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? [1] No Leer No Taxing district Key number/Legal description Record number(contract) Page number(contract) 6.6vithei1 J4,0241Lp 2./a)- ezz)-9,713_,),) INVe certify under penalty of perjury that the above and foregoing information is true and correct. Signature of ap licant Address of applicant (number and street,city,state,and ZIP code) y_ Y99q, /Zop a.e../ca&ial- s,,kg7 - Signature on d representative 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) yf1 /C-Aely L el<kt, FILEDName of contract seller Taxing district MAY o 5 2023 • "thicizAzz Key number/legal description a GIBSON COUNTY AUDITOR 26-21- -30-1-/DD-* evo, 91/3- �©/ Signature of County Auditor Date signed(month,day,year) zo Notice of Award o CHERYL L SICKMAN 8999 SOUTH 1200 EAST OAKLAND CITY, IN 47660 See Next Page