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Disabilty_Gordon
Reset Form f"!'. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR r� ," .1 ,= DEDUCTION FROM ASSESSED VALUATION + / State Form 43710(R14 19-24) \',SLY) i '!'!. Prescribed by the Department of Local Government Finance 02S 10'24 Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. INSTRUCTIONS: To be fled 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 Name of Applicant (owner or contract buyer) \-Nr)'t. ‘k °\©A.L I\ . Is applicant the sole legal or q4itable owner? If No, what is his/her exact share or interest? ' so an spouse, indicate with whom Yes ] No If name on reco is different than that of applicant, indicate below: OCT 1.8 2C25 Na ri c Contract Seller ,f5 ress of Contract Seller (number and street, city, state, and ZIP code) Is4rup, 1 pd OUNTY AUDITOR 'A 'eal 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 disabed and una+ • to ., + +• in any substantial gainful acivrty as defined in IC 6-1.1-12.11(d)? Yes ' o Yes n 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? es W No D Yes No Taxing District Key Number I Legal Description Record Number (contract) Page Number (contract) 0 * 2 C -\ 2. 1 ao .- z8 . D IIWe 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, state, and ZIP code) ()•- v\ ,- 3n — L&(‘': lJ 71 JA,L6L... , . doki N F -\ c/kk..FL1 Signature of Authonzed Representative Address of Authorized Representative (number and street. city, state, and ZIP code) o Notice of Award C 0 IIII IIII 111 1 II I � III 111111 I II II ill O 0000340 00029958 3 MB 0.622 0131 M3MCS6PI T224 P17 • •, r TRINA C GORDON o • irrt •• 619 E OAK ST PRINCETON, IN 47670-1617 You are entitled to monthly disability benefits beginning June 2023. C See Next Page i