Disabilty_Meyer .0e^,r.q, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
_ f`' DEDUCTION FROM ASSESSED VALUATION
~' State Form 43710(R13/1-20) Gibson Haubstadt 2024
�`+ r�' 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.
Name of applicant(owner or contract buyer)
Sheila K Meyer
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:
Yes ❑ No
If name on record Is different than that of applicant,indicate below:
_ _ _ _ _
Name of contract seller __ _.
N/A
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
® Real Property El Annually Assessed
N/A Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21 1)21 • Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes NI No ®Yes ❑ 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?
j Yes ❑ No ❑Yes ® No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Haubstadt 26-18-36-401-000.651-009
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
"Signature a applicant 9 Address of applicant (number and street,city,state,and ZIP code)
1004 Adams Ct., Haubstadt, IN 47639
Signatur of authorized represents a Address of authorized representative (number and street,city,state,and ZIP code) •
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of applicant Date filed(month,day,year)
Sheila K Meyer •
Name of contract seller FILED
N/A
Taxing district MAY 0 9 2024
Haubstadt
Key number/legal description (tj a. j t
GIBSON COUNTY AUDITOR
26-18-36-401-000.651-009
Signature of County Auditor Date signed(month,day,year)
''S‘C- Cat: CA-0-0 \iTha.iAL i(Nt: i
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516124,
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