Disabilty_Winstead .. J , ResetForm
�`,"�", APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
0 ' i DEDUCTION FROM ASSESSED VALUATION
� ° e'' State Form 43710(R14/9-24)
I i . 6' 5
sots Prescribed by the Department of Local Government Finance ;
1
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 payable.
See reverse side for additional instructions and qualifications.
Name f plicant(owner or contract buyer)
O),A[3rEA
Is applicant the sot egal or equitable owner? If No,what is his/her exact share or interest? , If ow ed pouse,indicate with whom
"Yes O No FEBIf name on record is different than that of applicant,indicate below: FEB B 27 203 i,li ,
II
Name of Contract Seller ArAv2' a. •
GIBSON COUNTY AUDITOR
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
Real Property 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)?
0 Yes No I'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?
Nlites 0 No ❑Yes XNo
Taxing District Key Number I Legal Description Record Number(contract) Page Number(contract)
OA( bovtiviiLl 2p-lo-3‘1-4t64;01. 14
IIWe certify under penalty of perjury that the above and foregoing information is true and correct. .
Signa e of Applicant Address of Applicant(number and street, ity,state,and ZIP code) 1065
X ttil L ' — - . 61(60 at5-r. o-D Soetr74 Ot0EAULLe,
Signature o Aut riz Representative Address of Authorized Representative(number and street,city,state,and ZIP code)
Notice of Award
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PEGGY J WINSTEAD
6700 WEST 450 SOUTH
QWENSVILLE, IN 47665-9110