Disability_Carlile (2) 1 w�„ APPLICATION FOR BLIND OR DISABLED PERSON'S C UNTY I TOWNSHIP YEAR
_i_.. DEDUCTION FROM ASSESSED VALUATION
1Satz Form 43710(R13/i-27)
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+/ Prescribed by the Department of Local Ggvernmen;Finance
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
-
,
of-ppiicant(c�.ner or cone/..t buyer)Gv ) ik .
Is eppkant the sole legal or epuitat'e on. sr? I;No,what is his:her exact share c`interest? If owned with eons other than spouse,
V I indicate with h
r Yes ❑ No j
If name on record is different than 'at o,applicant,indicate below:
S El)
Name of contract seller �� D1
\ � /, � GfesO�c � ��zQ
A Ai ooQ
Address., an'ract se'_r(m•roer Ps:eel city.state.and ZIP cods) th property in ou�6 ••
Real Property �reQ, ually Assessed
\ Mobile Home(IC 6-1.1-7)
app!i- nt bl' d as defined in IC 12-7-2-21(1)" Is applicant disabled and unable to ngage in any substantial gainful ac'v ty
as defined in IC 5-1 1-12-11(d)?
,,•ves No Yes ❑ No
.ne,property used and occupied primarily for his/her residence', V Does the applicant's taxable gross income for the preceding cafe dar year
exceed 517,000?
Yes ❑ No ❑ Yes No
Taxing district Key nu be /Legal description Record number(contract) Page numbe (co rad)
0 t 4-- Pr( d()a — 57- ►I 3 -goo ?o G. oa
INVe 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)
x � .
Signature of authonz representative I Address of authorized rep- entative (number and street.City.state.and ZIP code) L1� G I ,0
II 4
E
I RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name of applicant -- Date k\(1‘-)\
G
\\ \
FILED
filed(month,day year)
Nameofcontracer
SEP 0 9 2024
Taxing district ,,�r�� 1
( / Iii-- GIBS Lf�NTy
Key number/legal dex-ript:on AUDITOR
2_L-o2_-s7 .__\.\s__000 ,y-o6 _o\--I--
Signature of County Auditor
�/ ,� 1�'q^ Date signed(month,day.year)
V v V '
lift'�,, �\,
Notice of Award
0923 MCS,PC7,1,DA,T109,058,153 000016034 03 MB 0.118
KIMBERLY A CARLII,E
3215 OAK IHILL RIB
EVANSVILI.,E, IN 47711-3671
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