Disabilty_Morgan (2) <4..- 4, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
!'1'7,'.:�a,, DEDUCTION FROM ASSESSED VALUATION i
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"' State Form 43710(R13 I 1 20)
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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 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.
Name of applicant(owner or contract buyer)
k m Tt)
Is applicant the sole legal or equitable own r? If No,what is his,'her exact share of interest LEe
. 'meone other than spouse,
om:
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below: APR U 1 1024
Name of contract
Ar'itilda. ptith.4.1)
r GIBSON COUNTY AUDITOR
Addr n ct se r 1 u e and sheet,city state,and ZIP code) the roperty in question
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
as defined in IC 6-1 1-12-11(d)?
Yes No Yes ❑ No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding cale a year
exceed 517,000?
Yes ❑ No i ❑ Yes No
Taxing district Key number Legal description Record number(contract) Page number(cont ct)
0 2,6 26- 1q-li -101 -Q00 .081 -.0U .
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)
4
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Signature of authorize representative Address of authorized representative (numbe)and street,city,state,and ZIP code)
Notice of Award
ill iiillIliliiillil11n1i1i1i1IlI''ii'i'Ili'lili1l1iiill"11 I111
KIM E MORGAN
400 S LINCOLN ST
FORT BRANCH, IN 47648-1628
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