Disabilty_Zerr (2) , � APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
� DEDUCTION FROM ASSESSED VALUATION 1
State Form 43710(R131 1-20) [/�/1/2 C.�'>� ''. Prescribed by the Department of Local Government Finance �' i `� _I( D.
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark '
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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. 441 1 '-1U ^.
Name of applicant(owner or contract buyer) r
Is applicant the sole legal or epui able owner? I If No,whatis his:her exact share of interest? If owned with someone other than spouse
indicate with whom:
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 property
�, , Pe�Y in question
I, IX seal Property ❑ Annually Assessed
Tit 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 . 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?
SXs ❑ No ❑ Yes 'No
Taxing district Key number/Legal
^}description
\ Record number
(contract) Page number(contract)
A /
1 lANe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature licant Address of applicant (number and street.city state.and ZIP code) Q
it Ijroahor , reae,2e I ,ddress of authorized repres=,C;ativ= (nine a eet, j,state,andZlPcode)
I RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day year) •
iv�nt�salie� 2-4 Pi -'°'`- F ILED
Taxing district
AUG 21. 2024
c), ,
• 1Key number/legal description r a J'►'�{d&4-
O -'`r _ 1 y QO -`J 2� GIBSON COUNTY AUDlTOE2
,Signature of County Auditor 1 Date signed(month,day.year)
1y ti-6...1?;"ti Ck 9 a .1 a_i"'L��. Y�' -\ F is ( /c.Q. q
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Notice of Award
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