Disabilty_Rudish *- "-:--,. APPLICATION FOR CREDIT AGAINST PROPERTY COUNTY T TOWNSHIP YEAR
I ;' •-:" TAXES FOR BLIND OR DISABLED PERSON
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State Form 43710 (R15 /7-25) AO (� CO 7Y�"gatii-1G I I
��. 41._�' Prescribed by the Department of Local Government Finance _ `
Instructions: To be filed 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 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 b er)
Is pplicant the Sole Legal or E itable Owner? If No, What is the Applicant's Exact Share or Interest? If Owned with Someone Other than Spouse, Indicate with Whom
Yes :‘j •Th 46:00t-'.ATE-•
If Nam on.Record is Differe t than that Of Applicant. Indic to Bel r
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 ❑ Mobile Home (IC 6-1.1-7) ❑Yes No
Is Applicant isabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Her Residence?
Yes ❑ No es ❑ No
Taxing Dis rict Key Number/ Legal Description Record Number(coat Rd) Page Number (contract)
0 deelel (2& 'lq- le -g R -00° 479' ._ Oo 7
I/We certify under penalty of p jury that the above and foregoing information is true and correct.
y,... Signature of Applicant Address of Applicant (number and street, city, state, and ZIP code)
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nature of Authorized Representative Address of Authorized Representative (number and street, city, state, and ZIP code)/
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND I DISABLED PERSONS
Name of Applicant Date Filed (month, da . la
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Name of Contract Seller
Taxing District , DEC 2 6 2025
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Key Number/Legal Description / 12 1'cu�.0 C.(i. J/Y Il1:. a✓:v114/
I y p O '00 0 , / 7 � ^ a 0 7 GIBBON COUNTY AUDITOR
Signature of County Auditor Date Signed (month. day, year)
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Pk, Sretl Copy 8
axr i. �` % iN Social Security Administration
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T=�� \ IIWI / Benefit Verifi L tter gcation
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T45 P2 185138-10-6-1 - 12053 BEV 1202
.'`"'?t JOSEPH RUDISH II FOR K g
RISTI D RU DISH
310 W WASHINGTON ST
012053 OAKLAND CITY IN 47660-1450
You are entitled to monthly disability benefits.
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