Disabilty_Whitehouse �E-^-6Z• APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
;�. 1i. DEDUCTION FROM ASSESSED VALUATION �SC7 ��
�•�,,, State Form 43710(R13/1-20) ,21-(
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+�07/ Prescribed by the Department of Local Government Finance '/1•Vl
Illi
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. ''nn��,,��
Filing Date: Form must be completed and signed
GIBSON COUN I Y AUDITOR
,
Is applcant the s legal or equitable owner', If No,what is his!her exact share of interest? If owned with someone other than spouse
indicate with whom:
l'es ❑ No 1
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
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)?
XYes ❑ No iyerYes ❑ 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$17,0007
VS Yes ❑ No ❑ Yes No
Taxing :ict Key number/Legal description Record number(contract) Page number(contrac)
otL /;-/8-.300l:6,00 , ?3/-aAS'
I/We certify under penalty of perjury that the above and foregoing information is true and correct
Signature of applicant/ I I Address of applicant (number and street.city state,and ZIP code)
6 I )6-4)10449,__ N 44/ -C /14z).//4` 4, ,zyncb.H. '/'26 6
Signature of(,)/411
ed representative Address of authorized representative (num'be an
d street, ity.sfafe,a 4ode) 6
1
I
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name of applicant Date filed(month,day year)
Name of contract se r FILED
Taxing di ict MAY 21 2024
Key number/legal description a...vY
GIBSON COUNTY AUDITOR
0?6 - 0Z -/F - Joy - 000 . 9 3/ _ o ,2.. s
Signature of County Auditor -Date signed(month,day,year)
/ /' I /"tr----
-- ° , ..
: 24T OK 1:;3629
REF: A it
CINDY I.1 NN WHITEHOt SE ,''
1601 S MAIN ST
PRINCETON IN 47670-3401