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• � ,;--- 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
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