Disabilty_Dearing ` "-'=•� APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
�' 1, DEDUCTION FROM ASSESSED VALUATION
_• '' State Form 43710(R13/1-20) /' ^l (7
*joy
Prescribed by the Department of Local Government Finance /`.•J• ( 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
.3.06e0\ / 5 fv e ' ec.(--,no) _
Is ap icant the sole legs quitable o:,ner' 'If No,w,at is hisTher exact share of interest? If owned with someone other than spouse,
indicate with whom:
17S14 ❑ 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
kli-Real 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
es as defined in IC 6-1.1-12-11(d)7
o ❑es No
Is the property used and occupied primarily for his/her re ce, Does the applicants taxable gross income for the preceding calendar year
exceed S17,0007
Yes ❑ No ❑ Yes I I-P}e---
Taxing district Key number/Legal description Record number(contract) Page number(contract)
c4 .�3rkv cIN �4c - Ig—\C‘_— l00 -co1. 5$-pat,
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)
_ 667 5 L t�c�le\ 54 f N-- t�rtr..�clr. 4/ 4764
hzdese
ve Address of authorized represents ive (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)
JC)5 e0\ ? ' ac-‘ ,./ 5
Name of contract seller
Taxing district FILE D
2\--- \J,-c,. ,-,
Key number/legal description
NOV 0 9 2023
Signature of County Auditor 41/1040t :g4��'` W)
/114J- t / dllittON BOUNTY AUDITOR
NOTICE OF APPEALS COUNCIL DECISIONSEP u 20
Ip
FULLY FAVORABLE