Disabilty_Voegel 7
"^"' APPLICATION FOR CREDIT AGAINST PROPERTY
' �-`+. ~��\ COUNTY TOWNSHIP YEAR
a' .,` 1 TAXES FOR BLIND OR DISABLED PERSON —
�' State Form 43710 (R15 / 7-25)
''' `f�_�•�•_,� Prescribed by the Department of Local Government Finance LALI2SC)( ‘ �
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_
Seereverse side for additional instructions and qualifications.
Name of Applicant (owner or contract buyer)
Owned with Someone Other than Spouse, Indicate with Whom
es ❑ No
If Name on Record is Different than that of Applicant, Indicate Below: i
Name of Contract Seller Address of Contract Seller(number and street, city, state, and ZIP code)
Vs------ P
Is the Property in Queetstion. Is Applicant Blind (as defined in IC 12-7-2-21(1))?
1R/ ❑eal Property ❑ Mobile Home (IC 6-1.1-7) Yes Ll<
•
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Pnmanly for His/Her Residence?
DC ❑ No es ❑ No
Taxing District Key Number/ Legal Description Record Number (contract) Page Number (contract)
ke i-(NV Ok()) N C\e—-—(r i . L-(2 —1U --45'.. 3 - vc0 . _.. 0
( _.
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of ApplicantAddress of Applicant (number and street, city, state, and ZIP code) l'G
(-z.../.(..\44,/eLe 4_50c)\ 02 .. 1 C _).._ - I i)
OSI—k_ N.VI
Signature of Author' ed RR h :" '
Address f- uthoriz Representative
9 P o ed (number and street, c/t , state, and ZIP c }
6:::57. /:
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND I DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
'f- 6) --t-., OIL ceE9ei FILED
Name of Contract Seller
Taxing District J A N 09 2026
Key Number/Legal Desclipti n &/')242.� � � / a .1/fratoe- nd)
D\D_ _ _c2 - -. coo �2 Q.z _ t GIBSON COUNTY AUDITOR
Signature of County Auditor J Date Signed (month, day, year)
2. Call us at 1 -800-772-1213, weekdays from 8:00 am. to 7:00 pm. If you are deaf or
hard of hearing, call TTY 1 -800-325-0778. Please mention this letter when you call.
3. You may also call your local office at 1 -877-768-5679.
SOCIAL SECURITY
2300 N GREEN RIVER RD -�
EVANSVILLE, IN 47715 -�' p1