Disabilty_Gibbs .tN APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEARDEDUCTION FROM ASSESSED VALUATION
l l► State Form 43710(R13 I 1-20)/ Gson 021 Montgomery
rate%�•' Prescribed by the Department of Local Government Finance
File Mark
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
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Name of applicant(owner or contract buyer)
Paul Gibbs
Is applicant the sole legal or equitable owner? If No,what is his/her exact share of• I':.wn°•with someone other than spouse,
i f4r ica j with whom:
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below:
NOV 0 6 Z024
Name of contract seller
GIBSONO�Y AUDITOR
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)
Isapplicant 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 ® 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?
IZ Yes ❑ No ❑ Yes ® No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
021 26-17-16-400-004.838-021
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)
6888 S 1050 W Oville, IN 47665
Signature of authorized representa e Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
Paul Gibbs
Name of contract seller
io 0 6 2024
Taxing district
021 GIBi saN OU TY A
Key number/legal description
26-17-16-100-004.838-021
Signature of County Auditor ' Date sig d(month,day,year)
_.,
t'
o t i are entitled to monthly disability lieritiOw.
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