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APPLICATION FOR CREDIT AGAINST PROPERTY ELL D
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TAXES FOR BLIND OR DISABLED PERSON HIP YEAR
State Form 43710(R15/7-25) So 0 c , �J 2_- ,4101 ..- Prescribed by the Department of Local Government Finance (5--DEC 3 O2� !��
Instructions: To be filed in person or by mail with the county auditor of the county where the properly is located. t�
Filing Date: Form must be completed, signed, and filed by January 15 of the calendar year in which th - op t vr")-(7st.dean payable.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Name of Applicant (owner or contract buyer)
with Someone Other than Spouse, Indicate with Whom
„Otires ❑ 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: Is Applicant Blind (as defined in IC 12-7-2-21(1))?
Real Property D Mobile Home (IC 6-1.1-7) ❑Yes .❑ No
Is Appli nt Disabled a • Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Her Residence?
l Yes ❑ No ;6 Yes ElNo
Taxin istrict \k Key Number! Legal Description Record Number(contract) Page Number(contract)
4‘bt—fi A -off- zti -JoV 000, 604 D ,zD
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of A cant Address of Applicant (number and street, city, state, and ZIP cod
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Si lure of Authorize Represents ' Address of Authorized Representative (n mber and stree city, state, an ZIP code)
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RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
„e--"*.rde----41" .7 . FILED
Name of Co ract Seller
Taxin strict DEC 2 3 2025
Key Number/ Legal Description 7flzr.,h,/.4e C2 _14 Y. n,&
0 i1- a , 3 7 / , O 00. GIBSON COUNT/ AUDITOR
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Signature of County Auditor Date Signed (month, day. year)
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Social Security Administration
Supplemental Security Income
7.
Notice of Award
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STEPHEN CARL SEANEY
ip• 304 SCHOOL ST '
on PATOKA I:V 47666-9279
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• You were found disabled on February 23, 2017.
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