Disabilty_Seale i. 5
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rr° Q APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
�-; z DEDUCTION FROM ASSESSED VALUATION
';%' State Form 43710(R1419.24) oOO 302-C
4111 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)
non Seo1e . ILED
Is applicant the sole legalquitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,indicate with whom
❑Yes ❑No JUN 12 2025
If name on record is different than that of applicant,indicate below:
A:dleid(2 ,P6-
Name of Contract Seller GIBSON COUNTY AUDITOR
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
Real Properly 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is appficant disabled and una a to ge in any substantial gainful activity as defined in IC 6-1,1-12-11(d)?
❑Yes o 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 ye ex ed$17,000?
❑ es Q No ❑Yes
Taxing District ey Number I Legal Description Record Number(contract) Page Number()(to
ct)
LPL . 2fl3oOOO.lSVroO.ss
IIWe certify u •• pen ty of perjury that the above and foregoing information is true and correct.
:'� f li Address ofApplicant numberandstreet,city,state,and ZIP
9 • PP , , ( ty code) L
\O
U300 8 s -Tytv\ - a()-
1- a9
k ,
ignat/of zed esentative Address of Authorized Representative(numberandstreet,city,state,and ZIP code)
Notice of Award
•
ANTHONY W SEALE
PO BOX 87 _
FRANCISCO, IN 47649
You are entitled to monthly disability benefits beginning April 2009.
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