Disabilty_Montgomery APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
_\. DEDUCTION FROM ASSESSED VALUATION
* State Form 43710(R13/1-20) /-I_ CD/UrnDc.i
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Prescribed by the Department of Local Government Finance t bJ5n W/1 (2/
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)
� e5 E
Is applicant the sole legal or equitable o:+ner" if No,what is his:her exact share of interest? If owned with someone other than spouse,
indicate with whom:
res ❑ 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 property in question
rigo<1 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 Li-Tres ❑ 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 ['IQo
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Co ium Lick %-/3-13-500—COD.177-ork
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
S nature of applicant !Address of applicant (number and street.city state,and ZIP code)
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Sig A. of authorized representati 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)
aAlArrS r FILED
Name of contract seller
Taxing district MAY 16 2024
C O lum\t.; %��l apir.46;.,071/
Key number!legal description
GIBSON COUNTY AUDITOR
A- 13-13 -3o0-ODD, I1-) _o(- t�/{J-
Signature of County Auditor Date signed(month,day,year)
Notice of Award
Office of Central Operations
1500 Woodlawn Drive
Baltrncire, Maryland 21241-1500
Date: May 24, 2002
Claim Number: 304-62-4050HA 0
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JAMES E MONTGOMERY JR
6029 JAMESTOWN CT
EVANSVILLE, IN 47715-3453 H
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