Disabilty_Cartwright �.,, , APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
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g�:.'��:•��� DEDUCTION FROM ASSESSED VALUATION
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�•J ';L�' State Form 43710(R13/1-20)
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''� -"%'�' Prescribed by the Department of Local Government Finance
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\. 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
Name of applicant(owner or contr t buyer) I �(
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Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
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indicate with whom:
❑Yes ❑ No
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If name on record is different than that of applicant,indicate below:
NOV OR 2024
Name of contract seller
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Address of contract seller(number and street,city,state,and ZIP code) CtD:,ON COUNTY r1UDl i OR Is h roperty in question:
Real Property ❑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)?
❑ Yes XNo Yes ❑ No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding cal dar ar
exceed$17,000?
Yes ❑ No 0 Yes No
Taxing district Key nu be Legal description Record number(contract) Page number(confr t)
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2h t2�-1- I oL-o00. 3 c .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant �n Address of applicant (number
andl street,city,state,and ZIP code)
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Sig ature of authorized representative • Address of authorized representative (number and street,city,state,and ZIP code)
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RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND!DISABLED PERSONS
Name of app'cant
(� � k r�k /�� _I - Date filed(month,day,year)
Name of contract seller
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Taxing district
(-2---g NOV Q$ 2024
Key number/� Ad./legal description � a ruk,nd)
(.2�re/ -- i`� 07,-- f D'*-00/ 2-19 �-- 0v GIBSON COUNTY AUDITOR
Signature of County Auditor t 1 lJ V Date signed(month,day,year)
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RE: Mark Cartwright
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