Disabilty_Edwards /4_���, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
` \ DEDUCTION FROM ASSESSED VALUATION -
' State Form 43710(R13 I 1-20; d oz
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t 2(I
e1e'It-r� Prescribed by the Department of Local Goverment Finance `�0
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
Name of_ cant(c., _'or con; — — ---
kOl CL
Is a::.: sole legal ° .7) if No,';hat is his'her exact share of interest.% If owned . c ,a
i
i irdicat tr'v'
i
jYes ❑ No
If name on record is different than that of appl cant,indicate be'o; J— — __ JUN-1 3 2024
Name of contract seler ..—Aiart..,te,ilii,
GIBSON COUNTY AUDITOR
Address of contract se'ier(number a7d s''ee` aty state and ZIP code) Is th/property in question
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is appIIcant bind as def ned 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)7
/ es __ No Yes ] No
Is the property used and occupied primarily for his'her reside-c,.. Does the applicant's taxable gross income for the preceding tale dar y a'
exceed S17,000/
A Yes ❑ No ❑ Yes No
Taxing district Key ,tuber ega!description Record number(contract) Page number contr ct)
i --\ 2....._ . 2.t.-1?-Is- LI oil --001 ‘3of 102-c
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
g e of applicant I Address of applicant (number and street city state and ZIP code)
- 61 (10 (10CY)-1- Si' Hifkii c (DY)
Signature o authorizedreu'_se ra.r: Address of authorized repesentat:ve (number and street,city state.and ZIP code)
1
Notice of Award
LARRY M EDWARDS
1021 N GARVIN
EVANSVILLE, IN 47711
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