Disabilty_Wolf V, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
����-,,�s�$ DEDUCTION FROM ASSESSED VALUATION
,.a.:,` State Form 43710(R13/1-20) Gibson 007 2024
�----1` 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: Formmust a are et due
completed
and
signed
payable.y ecember 31 and filed or postmarked by the following January 5 of the calendar year in which the
property
See reverse side for additional instructions and qualifications. _
Name of applicant(owner or contract buyer)
Denise Wolf
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,
in m:
0 Yes ID No IE'ILA,
If name on record is different than that of applicant,indicate below:
JAN 1 5 2025
Name of contract seller �`� !�
Address of contract seller(number and street,city,state,and ZIP code) / / <'e athk� eitestion:
GIBBON COUt�YKe49rope 0 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 WINo ®Yes Li 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 0 Yes VINo
Taxing district Key number/Legal description Record number(contract) Page number(contract)
027 26-14-18-401-000.189-007
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si appli nt a ) Address of applicant (number and street,city,state,and ZIP code1 )
231 N Gibson St, Oland City IN -47660
I
Signati o uth ed rgpr ntaave Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DIS
ABL ED PERSONS� day,year)
Name of applicant TT °'�"°'�CDenise Wolf ■■ 1.�' L-/
Name of contract seller
JAN 1 5 2025
Taxing district /
027 �uu.0 a. .L� ma)
ulbSOriI t.,UWTY AUDITOR
Key number/legal description
26-1 a o18-40 189-007 / � Date signed(month,day,year)
Signature of County Auditor /�
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Social Security Administration ,5
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_. , al -,-- Benefit Verification Letter
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Type of Social Security Benefit Information .17
You are entitled to monthly disability benefits.
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