HomeMy WebLinkAboutDisabilty_Tichenor �E-,f?. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
` .a °_ DEDUCTION FROM ASSESSED VALUATION
1State Form 43710(R 13/1-20)
+'' ;* Prescribed by the Department of Local Government Finance �t P' ZO Q4
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
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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:
Ve's ❑ 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 pr erty in question
eal 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 LCJZ es ❑ 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?
es ❑ No ❑ Yes pefcrcr
Taxing district Key number/Legal description Record number(contract) Page number(contract)
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I/We certify under penalty of perjury that the above and foregoing information is true and correct
Signature of applicant I Address of applicant (number and street,city state,and ZIP code)
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Signature of authorized represent e Address of authorized representative (number and street,city,state.aid ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month.day year)
r„,\L \ I cieNe_te4:i • FILED
Name of contract seller
Taxing district MAY 15 2024
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Key number/legal description
GIBSON COUNTY AUDITOR
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Signature of County Auditor Date signed(month,day,year)
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0243303 00243303 1 AB 0.537 ('N61,NA TR33 PIR
f COLA MO4 11/19 457 23S1807A80656
ELMARIE YVE'I"['E TICHENOR
FOR FRANK J TICHENOR
1401 WEST VINE ST
PRINCETON IN 47670-1105