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Disabilty_Straeffer Jr thr\' )OA Reset Form "t APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR J ---- ••rii 1 DEDUCTION FROM ASSESSED VALUATION /1 r State Form 43710(R14/9-24) /�//1/v i,r/ (5 O1• Prescribed by the Department of Local Government Finance L(f//��//V 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,signed,and filed by January 15 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. Name of pplicant(owner or contract buyer) ___......aw Is applicant the sole legal or equitable owner? Ifflo,what is his/her exact share or interest? If owned with someone other than spouse,indicate with whom tj Yes ❑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: ,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)? 0 Yes XNo "Yes 0 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 0 No ❑Yes VNo Taxing District Key Number I Legal Description Record Number(contract) Page Number(contract) dN Li J 16 k( a6-lq j(r3©©-661, qs-1-oas- I/VVe certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Address of Applicant(number and street,city,state,a ZIP code) X 12)'-. --1 ..., )••••" agog E 6D0 5 A(Aikr -1-/ /04j/6 Lig Signature of Authorized Representative u 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, )4-111� F LED Name of Contract Seller e Taxing District FEB 2025 /, 6.a6— /10 1 ,Oil Key NumberI Legal Description Addy?. f a. I • (9 1gr/1.-- ,6 D 1 �'/, Q6-7 e_oA GIBSON COUNTY AUDITOR Signa of CoSnty Auditor Date Signed(mon ,day,y ar) Notice of Award' 8 4 Q 6II1I111IIII11111111111IIIIIIIII"I"I1IIt1II11It11IItt11111I11 O 0000428 00031603 3 FP 0.636 0204M3MCS6PI T213 P17 c DAVID STRAEFFER JR 3889E 6p0 S 8 FORT BRANCH, IN 47648-8554 You are entitled to monthly disability benefits beginning March 2024. ?0?S Gigs otico�Q 411, 0 Pro C See Nexi)' /roZ