Disabilty_Morgan - ' R� % APPLICATION FOR CREDIT AGAINST PROPERTY
• . t COUNTY TOWNSHIP YEAR
4' . t i4 TAXES FOR BLIND OR DISABLED PERSON
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e . • �`�+ State Form ____,R15!7-25SOO 0 1. - ---,
V Prescribed by the Department of Local Government Finance
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Instructions. To be filed in person or by mail with the county auditor of the county where the property is locate .
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)
with Someone Othe ' n Spo i ', 'irate with Whom
Yes ONo
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If Name on Record is Di er nt than that of Applicant, Indicate Below: ireQkcerb 44,
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Name of Contract Seller Address of Contract Seller(number and street, city, state, and ZIP code 'v
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41,4., Z...,
Is the Prope in uestion:
yIs Applicant Blind (as defined in IC 12-1•2•21(1))? l . ' .
Real Property Mobile Home (IC fi-1,1-7) li Yes a No
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Pnmaril fo HistHer Residence?
Yes El No Yes Ej No
Taxing District Key Number!Legal Description Record Number (contract) Page Number(contract)
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IiWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signale of Applicant f Address of Applicant (number and street, city, state, and ZIP code)
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Signature of Authorized Repr entati Address p ofAuthorized Representative(number and street, city, state, and ZIP code)
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VAUGHNETTA S MORGAN
4275 W 850 S
FT BRANCH, IN 47648
You are entitled to monthly disability benefits beginning February 2018.
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