Disabilty_Weber <<-yr:. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
_o. DEDUCTION FROM ASSESSED VALUATION ^y��
�•� ' State Form 43710(R13/1-20) Gib�' Prescribed by the Department of Local Government Finance Gtv��� ��wn,A%P a�
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 mall 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 contract1
buyer)
?w ie e# Kai W1Q r
Is applicant the sole legal or equitable owner? If No,what is his.'her exact share of interest'/ If owned with someone other than spouse.
indicate with whom:
EYes ❑ 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) t property 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 u ble to ge 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 calendar year
-/ exceed S17.000?
2 Yes ❑ No ❑ Yes [ITT
Taxing district Key number/Legal description Record number(contract) Page number(contract)
?MOVO1/4 to wvSh;e 6— II—o(—/Oo—coo. oe7-oar
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
^a re o`app':ca^t Address of applicant (number and street.city.state,and ZIP code)
�� V��� 1017 w ISo N ?r; e4oti -I-.N 76 7o
Signature of authorized repre- live I Address of authorized representative (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)
?(Knike a We\teJ' _
Name of contract seller FILED
Taxing district APR 05 2024
alp 1� / tel gy p//tee)
Key number/legal description uc�C �J/y
GIBSON COUNTY AUDITOR
?Co - I)- of- /OD- G O, 089- ?
ur ucr . Date signed(month,day,year)
Alt `tja G-gV it/s7..) 1(
q
NE
I Ilia ill l i ilil i l i nl 11 it i t III z
PAMELA KAY WEBER
1017 W 150 N
PRINCETON IN 47670-8544
You are entitled to monthly disability benefits.
See Next Page