Disabilty_Slaton -"—' ,, APPLICATION FOR CREDIT AGAINST PROPERTY
t :- 1 TAXES FOR BLIND OR DISABLED PERSON COUNTY TOWNSHIP YEAR
a _, - r
State Form 43710 (R15/ 7-25) r�n C
.. r, Prescribed by the Department of Local Government Finance (S01 I
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 o pplicant (owner or contract buyer)
with Someone Other than Spouse. Indicate with Whom
0 Yes �No &./ea-N---9-4-ertio—Yi-,- --- ,
r
If Name on R4Ord i iffe rent 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))?
eg Real Property ❑ Mobile Home (IC 6-1.1-7) ❑Yes LNo
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Pnmarily for His/Her Residence?
:11 Yes D No ,es ❑ No
Taxing jict Key Number/Legal Description Record Number(contract) Page Number(contract)
a...c,eie.„),71,,,A70
.96 - //- 36 -(2. 4 0 - O D6e •goi - O O .01 7
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
S. nature of Applicant / Address of Applicant (number and street. city, state. and ZIP code)
-7- c-:-3q c5 S `�L cL iv c. n L1 G
Signature of Authorized Representative Address of Authorized Representative (number and street. city, state, and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS F i L
Name of Ape .nt Date Filed (month, day, year) E.
jog
A—e+61- )1L)
J
Na = • , ontract Seller
(i►.'.
- , _ DEC 2 3 2025
Taxing lid
4 :2.... •____/e_e____. _--) 4..... (7--124aUZZ/. a. iiiit,‘„,,,,
GIBSON COUNTY AUDITOR
Key umber /Legal Description
d,b -- // - 3t - 01oa - flag. 90i - all 7
Signature of County Auditor Date Signed (month, day, year)
MINIM
0
=` .�� Social SecurityAdministration
'gill Benefit Verification Lettertii
MIME
ammo
'IIIIIl"II'I'I,IIIIIIIIIIIIlilulIIlil1I"I'Il'II,IIllliurlliuli
ROBIN LYNN SLATON
C OPY
3595 S 50 W ?al
PRINCETON IN 47670-9200
You are entitled to monthly disability benefits.
See Next Page