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7' APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY I TOWNSHIP IY AR
DEDUCTION FROM ASSESSED VALUATION
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State Form 43710(R14/9-24)
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 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Name of Applicant(owner or contract buyer)
Ai E/Ifik -e-s-r 01 Ot-cir- -
buyer)
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 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:
X Real Property El 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 ' (Yes O 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?
)(Yes 0 No .,tes No
Ta •p District
Rrkfcr-o kJ 0,28 g Key Number/Legal Description
Record Number(contract) Page Numb (cont ct)
''
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Address of Applicant(nu Fr and street,city,state,and ZI code)
&V.-441' C4.41,0 2 1 r( ittoilikrey 0,0** IN6E-7-0A-1I iki 4-7676
Signature of Authorized R esentative Address of Authorized Representative(number an street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS
Name of Applicant Date Filed(month,PILED
EARAIS-r- Aij ta-frE
Name of Contract Seller
JUN 0 3 2025 i
La
Taxip trict 1
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s
Key Number/Legal Description C41/1-.1 a .d 4 4:72 4)
GIBSON COUNTY AUDITOR
4-IA-,01-go 1-- al 636)-6 04
Signatu of County Auditor Date Signed(mont ,day,ye r)
j4t.--1e6c9' c Or o& () a
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EARNEST RAY WHITE
817 N SEMINARY ST
PRINCETON IN 47670-1652
You are entitled to monthly disability benefits.
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