HomeMy WebLinkAboutDisabilty_Smith "'`-A",,, APPLICATION FOR CREDIT AGAINST PROPERTY COUNTY TOWNSHIP YEAR
(ice. ?'i TAXES FOR BLIND OR DISABLED PERSON
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�J State Form 43710(R15/ 7-25) +1:f-- IN
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�/ Prescribed bythe 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 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 buyer)
Jennysmith.1976@yahoo.com
Is Applicant the Sole Legal or Equitable Owner? If No, What is the Applicant's Exact Share or Interest? ' If Owned with SomecAie Other than Spouse, Indicate with Whom
® Yes ❑No
It Name on Record is Different than that of Applicant. Indicate Below:
Derek Smith
Name of Contract Seller Address of Contract Seller(number and street,city, slate, and ZIP code)
Is the Property In Question: Is Applicant Blind(as defined in IC 12-7-2-21(1))?
®Real Property ED Mobile Home (IC 6-1.1-7) 0 Yes ISifNo
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for 's/Her Residence?
AYes ❑ No Yes ❑ No
Taxing District Key Number I Legal Description Record Number(contract) Page Number(contract)
aireAtelli-Leh, A&-0-‘34 - Wee- 009, 5-40-10.a/
lfWe certify under pe of perjury that the above and foregoing information is true and correct.
Sig tura of Applicant Address of Applicant(number and street, city, stale, and ZIP code)
6854 W 450 S Owensville IN 47665 United States
Sig re of Aut zed 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, dafrIL ED
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Name of Contract Seller
_ - j A 4 0 5 2026
Taxing District
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crh,,,.,/,,,,i a. pirit,6.424)
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Key Number!Legal Dess i t n
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GIBBON COUNTY AUDITOR
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Signature of County Auditor Date Signed (month, day,year)
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66111 Benefit Verification Letter
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JENNIFER EILEEN SMITH ,
man 6854 W 450 S
OWENSVILLE IN 47665-9184
You are entitled to monthly disability benefits.
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