Disabilty_Pierce Resef;Fgr.'m i • � ,;--- 4 APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR 7i;�-..- 1 DEDUCTION FROM ASSESSED VALUATION • State Form 43710(R 14/9-24) O\ J Q^ 2 2 �/ J �•�• Prescribed by the Department of Local Government Finance 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 Name of Applicant(owner or coot buyer) - '-e I eVCe_ , Is applicant the sole legal or equitable owner? If No,what is his/herE,lctict'ar or int es ■ ` If owned with someone other than spouse,indicate with whom ❑Yes ❑No 11�� � ,1J■ If name on record is different than that of applicant,indicate below: FEB 15 2025 Name of Contract Seller Address of Contract Seller(number and street,city,state,and ZIP co COUNTY COUNTY AUDITOR Is the Property In Question: Real Property ❑Annually Assessed Moble Home(IC 6-1.1-7) Is applicant blind as defined in IC 12-7-2-21(1)? A Is applicant disabled and unable to a in any substantial gainful activity as defined in IC 6-1.1-12-11(d)? ❑Yes / es ❑No Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar ye af e eed$17,00 ? es ❑No ❑Yes o Taxing District Key Number I Legal Description Record Number(contract) Page Number contra t) 0 26.12~i8-102-emu -617—©21'. I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Address of Applicant(number and f fleet,city,state,and ZIP code) Xl' ‘\_p_pOrl\ft_31?_ =pjlse_g‘,R. I\t")r'it f , D n— J\9-- ‘9-0 . Signature of Authorized Representative Address of Authorized Representative(number a%street,city,state,and ZIP code) RECEIPT FOR APPLICATION FOR DEDUCTION-FOR BLIND/DISABLED PERSONS - , Name of ç\PL A eivc e r Date Filed(:f1EIarI ,lI Name of Contract Seller t..._. eT FEB 2 5 2025 Taxing District Key Number/Legal Description 2(.\2- 1 S _10 2. 9 y- 617 -- 0 22 GIBBON COUNTY AUDITOR Signature off�County yA /^Auditor � Date Signed(month,day,year) ( a 029305 1 AB 0.406 0100 W T24P7 0127 03 �x HEATH A PIERCE 0 500 W WARNOCK ST LOT D2 PRINCETON IN 47670-1270 0 0 0 . 2. . t �\l C See Next Page