Disabilty_Straw Jr (2) •4 APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R13/1-20) (/� o3
Prescribed by the Department of Local Government Finance S�r ? �Y �1
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
Name of applicant(owner or contract buyer)
Lfco..././
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:
L_f 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'
I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? I Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1 1-12-11(d)7
❑ Yes 'No ❑ Yes E1Go
•
Is the property used and occupied primarily for his/her residence's Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
Yes ❑ No ❑ Yes L 1jo
Taxing district Key number/Legal description Record number(contract) Page number(contract)
� ce.kan a 6- ID- g-30 y- boa-(o3(Q- Dolt
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)
• a a Sow . . ; S7C- f\ceA-01.11-14./1-176 7t.
Signature of authorized 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)
Ccd L „SA- FILED
Name of contract seller
JUN 28 2023
Taxing district j_t' \ Ace lc on % za,zf a,l/f )
Key number/legal description _ GIBBON COUNTY AUDITOR
a(49 304 - o0a. 3(0 0 a g
Signature of County Auditor Date signed(month,day,year)
� `i% a (l3gs()3
Notice of Award
Mid-America Program Service Center o
601 East Twelfth Street
Kansas City, Missouri 64106-2817
Date: June 9, 2023
BNC#: 23MS699G 19212-HA g
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0000701 00041520 3 MB 0.531 0605M3MCS6P1 T340 P17
CURTIS L STRAW JR
2105 S MAIN ST
PRINCETON, IN 47670-3413