Age_Dix •� APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
°i °` DEDUCTION FROM ASSESSED VALUATION
J State Form 43710(R13/1-20) A"-;e�:: Prescribed by the Department of Local Government Finance •�1b \
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 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.
Name of applicant(owner or contract buyer)
Vr \a i X _
Is applicant the so e legal or equita e owner? I If No,what is hislher exact share of interest? If owned with someone other than spouse,
indicate with whom:
es ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller
of
Address of co3ract seller(number and street,city state.and ZIP code) Is the property in question.
VrFe—al 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)?
❑ Yes lid'No Yes ❑ 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 S17,000/
es ❑ No ❑ Yes to
Taxing district Key number/Legal description Record number(contract) Page number(contract)
--h CCav J - ,. 12.-e-i -\-ko - oeo•0 --1oLo ,
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)
aX urt'- � c ,t - aQ a \. Po W l .' -1-_ f).,o-- - , ►.
Signa e of authorized representative Address of authorized representative (number and street)ity,state.and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day year)
Kf---keTh CAI ) X _
Name of contract seller FILED
�1 SEP 0 6 2023
Taxing district /� �j
•
Key number/legal description \ GIBSON COUNTY AUDITOR
OR
a,U� \ t - \o — Coo. IXo- O D
Signature of County Auditor • Date signed(month,day,year)
L19,-,, Q a . \ -, 2 g),, ,_.0 q - u -a.
Notice of Award
Office of Central Operations
1500 Woodlawn Drive
Baltimore, Maryland 21241-1500
Date: February 8, 2009
Claim Number: 307-58-4695HA
KENNA M DIX
401E LOCUST ST
FORT BRANCH, IN 47648-1416
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