Disabilty_Runau APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
_ .._. - ,,1 DEDUCTION FROM ASSESSED VALUATION 5 ,1`
' State Form 43710(R13/1-20) OM8h11 e
''''; �' Prescribed by the Department of Local Government Finance 6i6sor
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
$°( -
Name of applicant(owner or contract buyer)
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:
Yes ❑ 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:
L teal 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)?
es ❑ No 1 'S'es ❑ 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 517,000?
es ❑ No '" •s ► No
Taxing district Key number/Legal description Record number(contract) Page number anti.,
30 W\e..0 A\e _ aG -do -D - Lin- oat). pn(0- c�d3
I/We ce1Nf'ynder penalty of perjury that the above and foregoing information is true and correct.
i Iklff rGof yamle Address of applicant (number and street,city,state,and ZIP code)
. � `a79 5 �,.it~.sv.; �. Gat- C1 i4 `f7660
‘t:/t ..4,1,16,"/
of authorized r resentative Address of authorized representative (numntreet,city,state,and ZIP )
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
Name of contract seller FILED
Taxing district MAY 1 0 20Z3
504-Ner\I A\t. A kuC ae 1r1r
Key number/legal description GIBSON COUNTY AUDJTOR
06- ate—(5;— 1/6.3 --vob . DQ(o —003
Signature off County
yAuditor Date signed(month,day,year)
Notice of Award
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0000061 00018580 3 SP 1.050 1229M3MCS6PI T128 P
DARREL RUNAU
5279 S WASHINGTON
OAKLAND CITY, IN 47660-7703