Disabilty_Maikranz c ' is
F APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
..•. _ DEDUCTION FROM ASSESSED VALUATION
Slate Form 43710(R1311-20)
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�� Prescribed by the Department of Local Government Finance � /023 ,
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 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. ...
Ls6VName of a scant(owner or contractbuye NI
.
1401)1drii\ r Ioetu,z .
Is app: ant ' 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:
�� FL.:
Name of co tra2f feller
�� MAY 2 2 2023
` 1 dress contract seller(number and street,city,state,and ZIP code) Azdzetter7 Is`�e roperty in question:
\VMONCCN 2 Real Property AnnuallyAssessed
P Y
GIBBON 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 una le to a age 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 cale dar ear
exceed S17,000?
eS ❑ No = Yes No
Taxing district ' Key num er I L gal description Record number(contract) Page number con act)
O2J , 2/-I '36- 101-002.308 -oat .
I/We 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)
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Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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KENNETH RAY MAIKRANZ JR
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10048 S QUAIL XING
HAUBSTADT IN 47639-8674
You are entitled to monthly disability benefits.
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