Disabilty_Kruse APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
A' 14'` _.1..•`,% DEDUCTION FROM ASSESSED VALUATION
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;,,.i...„....4... State Form 43710(R13/1-20)
Prescribed by the Department of Local Government Finance 6,16sYcl 64,erbied
File Mark
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 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.
Name f applicant(owner or c tract buyer)
/ .
112a A , lehLgE--- (
indicate with whom:
VYes 0 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 in question:
0 Real Property 111 Annually Assessed
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)?
,.
1] Yes )4 No XYes 1:1 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?
VYes 0 No (-,Yes 'No
I
Taxing district Key number/Legal description Record number(contract) Page number(contract)
C)0 1 Olq a6,---- 0---00-2‘oo- "00 .d,31-ebf
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)
E 150 &- AT 674fal /A/t[Ial-70
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
41/410a, N41/4)8-, 411261„. 'V/g E/76-DS rm7ARAttie-#4 /Al i'Mzig
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name ILA
0_4 6; kkuse
Date filed(month,day,year)
FILE "I.'
Name of contract seller
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Taxing district NOV 04 2024
Y)2,,,Ald a pk44,;,41)
Key number/legal description GIBSON COUNTY AUDITOR
.6-.-- 0_go ,, ,00_00. a , sfs- eo 1
Signature of County Auditor Date signed(month, year)
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0000172 00016782 2 SP 0.880 0131M3MCS4PI T122 P
7806PAM NLiA00S0 KRUSE
ELBERFELD, IN 47613-8409
You are entitled to monthly disability benefits beginning August 2023.
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