Disabilty_Spindler APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
11l\ �> State Form 43710(R13/1-20) �� O 2-1-1
�y`; 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 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.
4141,4
Name of applicant(owner or contract buyer)
-11-0k_ CL--r a- pi r& T
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:
File‘ ❑ No r
If name on record is different than that of applicant,indicate below:
Name of contract seller
`�
1 - ,
Address of contract seller(number and street,city,state,and ZIP code) Is the pro rty in question:
A '� eal 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 12No 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?
Yes ❑ No ❑Yes No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
. �9Irl -Stare , DLL) (l- - i01 . (73-- fat
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sig22.9.1we of applicant Address of applicant (number and street,city,state,and ZIP code) (�
P
Signature f authorized representat Address M authorized representative (number and street,city,ithte,and and Z�
9
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND 1 DISABLED PERSONS
Name of applicant Date filed(month,day,year)
l aK,.1i1; ccl. iet— FILED
Name of contract seller
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DEC 2 7 2024 ,,W
Taxing district �`
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Key number/legal description GIBSON COUNTY AUDITOR
DX_Q_ a a- t -300 _ tac .
Signature of County Auditor Date signed(month,day,year)
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0000467 00052976 2 MB 0.515 1103M3MCS6P1 T435 P20 §
mt,3 TAMARA SPINDLER
RN 2304 W 1200 SOUTH
HAUBSTADT, IN 47639-8737
You are entitled to monthly disability benefits beginning December 2022.
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