Disabilty_Caldwell APPLICATION FOR BLIND OR DISABLED PERSONS COUNTY TOWNSHIP YEAR
:�‹', DEDUCTION FROM ASSESSED VALUATION ,
1
Sl.or. , ,in 43710 003 t I.:i,l Gson 1 021
Pros,rbed by the Detuartmenl of I of al Grr.nrnnre.ni I roan,e+ 2024
File Mark
Information cnntamed in this document Is CONFIDENTIAL pursuant In IC 6-1 1-35-9
INSTRUCTIONS To he filed In person or by marl with the County Auditor of Ihn county where the property is located
Filing Date Form must be completed And signed by December 3 t and flied of postmarked by the following January 5 0/the calendar year in which the
property taxes are Gast due and payable
See reverse skid for additional instructions and qualifications I
Name of applicant fawner co cunfnxY buyer)
Caldwell. Kathryn ____ ____-
Is applicant Inv wile leri.a or equitable owner/ It No,what is hrsmer exact share of interest' i�;,.. .,. ■/TT■/'�''y�''
indicate web.:.• •
❑Yes ❑nameNo
_ ----- - FEB 0 If on(de th ad is diffident than at of eppllcant.�ndicato below 9 2024
Name of contractnntraci seller
eller
GIBBON CO '
UNTY AUDITOR_
U
Address of contract seller(number and shunt city state,and ZIP code) Is the property in question ',
(✓ Real Property [_[Annually Assessed
Mobile Home(IC 6-1 1-7)
Is applicant blind as defined in IC 12.7.2-2t(1)7 Is applicant disabled and unable to engage In any substantial gainful activity
as defined in IC 6-1.1-12.11Id)?
❑ Yes No Yes Li No
Is the property used and occupied pnmanly for hrs/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed 517 000'1
l Yes [ No ❑ Yes re No
Taxing district Key number!Legal description Record number(contract) 1 Page number(contract,
021 26-17 29 100-005.559-021
1
UWe certify under penalty of perjury that the above and foregoing information is true and correct.
S nat a of- pliCDnt I Address of applicant (number and street.city state.and ZIP code)
1xI 11491 W 875 S, Owensville, IN 47665
Signature of authonzpd r: esentatian Address al authorized representative (number and street city state.and Z/P code(
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND 1 DISABLED PERSO
- - -
Name of applicant 1 DaSc •• at farI.Ie
Caldwell, Kathryn
Name of contract seik.r FEB 0 9 2024
-_-
Tdxmg diSlnCn -_- -- - //
yC a Jima)
021 I GIBSON COUNTY AUDITOR
-- - -
Key number,legal description -----on —_--- - - -_ - --
26-17-29-100-005.559-021
Signature of County Auditor --- rr
IM kOo kin 3 2(el 1 2o24 -
)
We found that you became disabled under our rules on September 26, 2012.
Type of Supplemental Security Income Payment Informatii n
You are entitled to monthly payments as a disabled individual. 11:
(>
i
"III'IIIIIIIII,IIIIIIIIIuiuisIsIIIIIIIII I'I I I"I'I'I I I'11'1 1 1 11l
KATHRYN G CALDWELL
22 CTY RD 9093
mimm
Flat Rock AL 35966