Disabilty_Pyle 11-r-'4'1 APPLICATION FOR CREDIT AGAINST PROPERTY = CO -
r LINTY TOWNSHIP � YEAR
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A' TAXES FOR BLIND OR DISABLED PERSON -�-
State Form 43710 (R15!7-25)k,,,,.. _ii;*,,/ ,,_SCY 02A
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Prescribed by the Department of Local Government Finance
Instructions: To be tiled in person or by mail with the county auditor of the county where the property is lot d.
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)
If Ow :'a '+ .' eon 1 j- Ouuse, Indicate with Whom
Yes EN0
If Name on Record is D a nt than that of Applicant, Indicate Below:
OEC 1 1 '1°15
Name of Contract Seller Address of Contact Seller(number and street, city, state, and ZIP code)
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N G��NT� AUDITOR
c"tasoh Property Is the i Question: Is Applicant Blind (as defined in IC 12-7-2-21(1))?
Real Property ❑ Mobile Home (IC 6-1,1-7) EYes No
Is Applican is bled and Unable to Engage in Any Substantial Gainful Activity) Is the Property Used and Occupied Primarily for His/Her Residence?
Yes 0 No Yes flNo
Taxing District Key Number/ Legal Descnption Record Number on act) Page Number (contract)
2 \aoo1
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I1We 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)
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ignature o Authoriz d Re resentative Address of Authonzed Representative (number and street, city, state, and ZIP code)
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Social Security Administration
Retirement, Survivors and Disability Insurance 044 0
Important Information
0002228 00112084 1 MB 0.622 0927M1T2R6PN T489 P24
- JEFFERY S PYLE
~ }; 1900 MEDICAL ARTS DR
APT 313
HUNTINGBURG IN 47542-9822
2024. We can
refund all of the Social Security money withheld.
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