HomeMy WebLinkAboutDisabilty_Bethel (2) .0^64„,, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
`�� DEDUCTION FROM ASSESSED VALUATION
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� State Form 43710(R13 I 1-20) n/ n
\�•'�'� Prescribed b the Department of Local Government Finance r3'n `�
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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. .- SlLf/
Nam nt(owner or contract buyer)
sitZtlt:
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 tha that applicant,indicate below
Name of contract seller .F1 ILED
Address of contract seller(number and street,city,state,and ZIP code) Is t roperty in question.
SEp 2 5 2023 eal 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 toe age in any substantial gainful activity
ti2/,cittiii a �� as defined in IC 6-1 1 12 11(d)?
GIBSON COUNTY AUDITOR ❑ Yes ❑ No Yes II No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding cale ar ear
exceed S17,000?
Yes ❑ No ❑ Yes No
Taxing district Key n ber/ egal description Record number(contract) Page number or tract)
CIE -12:40 B— 1 d 3 _but s1 'g- 024
. (3-.
I1We certify under penalty of perjury that the above and foregoing information Is true and correct.
i)
Signature o appli nt Address of On 1a li (number and street,city.st e,and ZIP V
9 PP PP G34L �� `ode)
i) ,_________ 2O---,---
- �— f)J9-(0, ,,,-
ure of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
•
JAMES L. BETHEL
710 N. WASHINGTON STREET
BLOOMFIELD, IN 47424
NOTICE OF' DECISION - FULLY FAVORABLE