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Disabilty_Scraper APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR ;% DEDUCTION FROM ASSESSED VALUATION State Form 43710(R13/1-20) l (( e•�•'' Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. NOV O Fa'Ile 2 rk INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. GIJaSOIy co?/ Yile' F9S9-rn which the Filing Date: Form must be completed and signed by December 31 and filed or postmarked by the following anuary o property taxes are first due and payable.See reverse side for additional instructions and qualifications. � Name of plicant(owner or contract buyer) Is applicant the sole le I or equitable owner? If No,what is his/h exact share of interest? If owned with someone other than spouse, indicate with whom: ❑ Yes ❑ No If name on record is different than that of applicant,indicate below: PILE Name of contract seller 410 l i O A ?024 Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: G/e s©N on, "Real Property ❑Annually Assessed N7�gUoTT Mobile Home(IC 6-1.1-7) Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and uh'fto engage in any substantial gainful activity as defined in IC 6-1.1-12-11(d)? ❑ Yes [ No Yes ❑ 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$17,000? Yes ❑ No ❑Yes Xo Taxing district Key number I Legal description Record number(contract) Page number(contract) cu, -1 ? -©/ - ct©g _COO, .2. .3 -0,ta_ I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant/ Address of applicant (number and street,city,state,and ZIP code) fr A/1 1-i� l� G E,(±S 1 hi Pit e-- si z< lr, O )enisvi Signature of thorized repre entative Address of authorized representative (number and street,city,state,and ZIP code) RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS Name of applicant ate filed(month,day,year) Name of cont act seller AM .� Taxing district 0 4 202� G/es ON Key number/legal description 14 -f 7 - 01 - yob - 66 o . 1 3 - v A a- Signature of County Auditor Date signed(month,day,year) L-147 ' �� - _ 7 IIiliIluI,ilnldillllhlluluihi4liiiliriidlgliinliuluiilli x JERRY WAYNE SCRAPER • 306 E MAPLE OWENSVILLE IN 47665-8709 You are entitled to monthly disability benefits. See Next Page