HomeMy WebLinkAboutDisabilty_Egbert Jr ,7"•,),. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
IA.-- • DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R14/9-24) d C7D
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
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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 faxes are first due and payable.
See reverse side for additional instructions and qualifications.
Name of Applicant(owner or contract buyer)
E3hS 1.4 le—•
Is applicant the sole legal or equitable owner? If No,what Is his/her e ..isct share or Interest? If owned with someone other than spouse,indicate with whom
[s1.4 0 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:
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ECIZProperty 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 Yese 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 exc d$17,000?
es 0 No O Yes ( 1<o".
Taxing District Key Number/Legal Description Record Number(contract) Page Number co cf)
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I/We certify under penalty of perjury at the above and foregoing information is true and correct..
Signatur f Applicant Address of Applicant(number and street,city,state,and ZIP code)
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Sig ature of Authorized Repr ntative Address of Authorized Representative(number a0 street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name of Applicant Date Flied(mrpri ED
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Name of Contract Seller
MAY 2 9 2025
Taxing District
V224;4azz a. aa-4,40
Key Number/Legal Description
GIBSON COUNTY AUDITOR
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Signature of County Auditor ' Date Signed(month,day,year)
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Notice of Award
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0000147.00015564 2 SP 0.970 0416M3MCS4PI T107 P o
ROBERT EGBERT JR
r= 1011 WEST DR
OAKLAND CITY, IN 47660-8965 •
•
You are entitled to monthly, disability benefits beginning March 2025. •
Enclosure(s):
Pub 05-10153
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