Disabilty_Dills APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
�; State Form (R13/1-20) r`C.x)� �
*",e••✓' Prescribed byy the the Department of Local Government Finance 1,)ka)(\
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 the county where the property is located.
Filing Date: Form must be completed and signed by December 31 and filed or
r•NeA't ctic3 C . i \`
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,
,�,//'' indicate with whom:
VYes ❑ 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:
1 f� of al Property ❑ Annually Assessed( T 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 134 es ❑ 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?
es ❑ No ❑ Yeso
Taxing district Key number I Legal description Record number(contract) Page number(contract)
taAL,oLA d 'ak —14—lS - - coo:1 V.(2- co-/ .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si nature of applicant Address of applicant (number and street,city,state,and ZIP code) 7� �c
Signature of authorized representative Address of authorized representative (number and street,city,late,and ZIP de)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
\ FILE
Name of contract seller
DEC 112024
Taxing district K\�
GIBSON COUNTY AUDITOR
Key number!legal description
On. —1.3 -03 .
Signature of County Auditor Date signed(month,day,year)
MINIM
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MELINDA GAYLE DILLS
106 W BRUMMITT STREET
PO BOX 594
OWENSVILLE IN 47665-0594
You are entitled to monthly disability benefits.
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