Disabilty_Harrington a
�E�n, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
/a _� DEDUCTION FROM ASSESSED VALUATION r
� ,'' State Form 43710(R13/1-20) //I,, 1'
\ Prescribed by the Department of Local Government Finance V 501�1 �nCk O
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
Name of applicant(owner or contract buyer)
FMA4 A0-rc-spa AU'1
Is applicant the sole legal o> quitable owner? 'If No,what is his.'her exact share of interest? If owned with someone other than spouse.
v indicate with whom:
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
e
Zeal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)2 s applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1 1-12-11(d)?
Ur
No U Yes ❑ No
Is the property used and occupied primarily for his/her residence? V Does the applicant's taxable gross income for the preceding calendar year
exceed S17,000?
E Yes ❑ No ❑ Yes- ❑ No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Toc--4- 3(-0VICL 0762-(1-t1- Iv -ooO. 333— co
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)
3o 5},i;,e.„ 5+. 1"o 3 r} c cw•cL. ;1-r1 Li ‘4 S
&.gn .ufepseat Y v C a;zed , Address of authorized representative (number and street,city,state.and ZIP code)
1
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day year)
Fr0,f.s- -f,h'F-o~ FILEDName of contract seller
Taxing district DEC 0 4 2023
Key number/legal description ?OOSON COUNTY AUDITOR 4/
o'er— t, k_`g_ tOD - COO, eg3_ 601
Signature of County Auditor Date signed(month,day,year)
/Vl4 , 13A-)0.4. t?-1 /a/y/ a3
l a- -1-a3: �4'Aoe_ o► io
��-.(1-,L. ' -1►�. ___ w,A. C . C - +I-d ickaLk yap; 4 _ (At 1 I
Franklyn A. Harrington
3600 Voight Rd.
Evansville,IN 47725
Notice of Decision Fully Favorable