Disabilty_Meece ' ,,m APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
ill' DEDUCTION FROM ASSESSED VALUATION
'1 State Form 43710(R13/1-20)
to
v Prescribed bythe Department of Local Government Finance TO\ �,,(�leis P . O1 I' V23.
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 31
Name of applicant(owner or contract buyer)
Sk\ckvo
_
Is appLcant the sole legal or equitable owner? If No,what is his,'her a- s re f inter J If owned with someone other than spouse,
indicate with whom:
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below DEC
1 5 2023
Name of contract seller nllittl C�'
VON COUNT"yY AUDITOR
Address of co t self^ umber and street,city,state,and ZIP code) I th property in question
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applic nt b nd as a IC 2.7-2-21(1)? Is applicant disabled and unable to ngage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
_ Yes No Yes ❑ No
I e property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding tale ar ar
exceed 617,000?
❑ No ❑ Yes No
Taxing district Key nu)Yes
1 egal description Record number(contract) Page numbe cont ct)
0 7/ ' ? Oo4-OoDZ .
IIWe 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
Y)2J2k-52.
62-3-sskie, sfi h, 0 0-1., 76t)
ignature of authorized representative Address of authorized representative (number and street,o ty,state,and ZIP code)
Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Award
Mid-America Program Service Center
601 East Twelfth Street
Kansas City, Missouri 64106-2817
Date: January 20, 2014
Claim Number: 315-60-8669HA
SHARON K MEECE
5248 S 650 WEST
HUNTINGBURG, IN 47542 /esOti 1�?�
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You are entitled to monthly disability benefits beginning December 2013.
The Date You Became Disabled
We found that you became disabled under our rules on June 26, 2013.
To qualify for disability benefits, you must be disabled for five full calendar
months in a row. The first month you are entitled to benefits is
December 2013.
What We Will Pay And When
• You will receive $1,176.00 around January 26, 2014.
• This is the money you are due for December 2013.
• Your next payment of $1,176.00, which is for January 2014, will be
received on or about the second Wednesday of February 2014.
• After that you will receive $1,176.00 on or about the second Wednesday
of each month.
• These and any future payments will go to the financial institution you
selected. Please let us know if you change your mailing address, so we
can send you letters directly.
• The day of the month you receive your payments depends on your date
of birth.
Information About Representative's Fees
We generally must approve any fee your representative wants to charge for
helping with your Social Security claim. The representative should send us a
fee request when he or she has finished all work on the claim. If the
representative will not charge a fee, he or she must tell us by sending a
signed and dated statement.
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