Disabilty_Cravens ^• APPLICATION FOR BLIND OR DISABLED PERSON'S
`"` �'� COUNTY TOWNSHIP YEAR
•
7a'C . a DEDUCTION FROM ASSESSED VALUATION
�` �' State Form 43710 R13/1-20
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�? Prescribed by the Department of Local Government Finance
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
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:
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❑ Yes No 64 t 6 in a IC) fr,, 1.,, (,,r-C-u--04,s
If name on record is different than that of applicant.indicate below:
Name of contract seller .
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Address of contract seller(number and street.city.state.and ZIP code) Is the/property in question:
'v •❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? ,(l0 Is applicant disabled and unable to engage in any substantial gainful activity
/ as defined in IC 6-1.1-12-11(d)?
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❑ Yes ❑ vibe-Yes Yes ❑ No
Is the property used and occupied primarityt )?tid/her residence? Does the applicant's taxable gross income for the preceding calendar year
�J exceed S17,000?
W Yes ❑ No ❑ Yes 1ZNo
Taxing district �VC)
Key number/Legal description Record number(contract) Page number(contract)
op 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)L. I ` k/ c, - 17 to 0 C ,S O Q c -►'G n(,)5 CO f /Pi. 11
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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 file�``�'h.dD
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Name of contract seller
IP JUL 2020r.r.
Taxing district
ol0 C Lk _ I QD cm . Q b _cc I GIBSON COUNTY AUDITOR '
Key number/legal description7
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Signature of County Auditor Date signed(month,day.year)
'\ -6\ILP0OL__SL1 d- )303-L 11QIz .
xan Social Security Administration
06784
T1 PO**SNGLP 156354-7-2-3-6784 BEV 0214
JOHN M CRAVENS
7760 EAST 500 SOUTH
006784 FRANCISCO IN 47649
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Type of Social Security Benefit Information
You are entitled to monthly disability benefits.
Suspect Social Security raud?
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