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~�`,:�'•a APPLICATION FOR BLIND OR DISABLED PERSON'S Co T YEAR
a - 1 DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R14/9-24) 1 i
\ I Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. MAY 0 J 9 2025
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
GIBSON COUNTY AUDITOR
Name o pplicant(owner or contract buyer)
F 41-,__/iyAl- fi
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or 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
Address yY
of Contract Seller(numb and street,city,state,and ZIP code) Is the Property in Question:
7 0 pl, ` 1/0.A.,rtjz"-- 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)?
❑Yes :iCJo es ID No
Is the property used and occupied primarily for his/her residence? 1Y/ Does the applicant's taxable gross income for the preceding calendar year exceed$17,000
it YesIDNo ElYes No
Taxing;trict Key Number!Legal Description Record Number(contract) Page Numbe contra t)
-!d - 09-y63-0e-3. 3 36-b.t 8
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 street,city,stale,and ZIP code)
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Signature of Authorized Representativ ' Address of Authorized Representative(number and street,city,state,and ZIP code)
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RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED :FILED
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Name of Applicant Date Filed(month,dr LE
Name of Contract Seller
MAY 0 9 2025
Taxingt�� , `
/2-z,duez a, saritilil7d)
GIBSON COUNTY AUDITOR
Key Number/Legal Description
' ' /A . o7 -Yo3 - va3 . 3 36 0..1 e
Signature of County Auditor Date Signed(month,day,year)
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Notice of Award
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0000088 00017440 2 SP 0.650 0716M3MCS6PI Ti 8
-;:r CARMEN F HILLYARD 6
.4, 624 S RACE ST 04
PRINCETON, IN 47670-2512
i bs° C unty DFR
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s 2 2020