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W--7; APPLICATION FOR CREDIT AGAINST PROPERTY COUNTY TOWNSHIP YEAR
' i �l TAXES FOR BLIND OR DISABLED PERSON
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- State Form 43710 -25) C n {, 1 �J / //� �)L,
Prescribed by the Department of Local Government FinanceU/ � O?'i O 1`h ,:J
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 r and payable.
See reverse side for additional instructions and qualifications.
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Name of Applicant (owner or contract buyer)
Owned with SSomeone Other than Sppet2 dicate with Whom
TAYes ❑ No Gee 1
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If Name on Record is Different than that of Applicant, Indicate Below: � CQ
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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))?
EI Real Property ❑ Mobile Home (IC 6-1.1-7) ❑Yeso
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Pnmarily for His/Her Residence?
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❑ No 0Yes ❑ No
Taxing District Key Number/Legal Description Record Number (contract) Page Number (contract)
00 0414 r1/41 A @AnilSujiLz-
ao f ! I-a o � vo0- I' '7- 603
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant ) - Address of Applicant (number and street, city. state, and ZIP code)
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191 ie)zq c ey_1-71,1/),i-u--_- 1-(--- 64--ki4-0 Ci-mi 1 kl LI-ya)t) .-Te74
Signature.of uthorized Represent - e l ( t'lCJddress 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,
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R(Et)p-t1 ,74,41-1(12t--AtCA-f--
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Name of Contract Seller
J A N 1 4 2026
Taxing District
0 4//4( t /.1-411) 0.A-nj 64/aattoE\I ii-t-t-,
Key Number I Legal Description t�i.e.‘-/Zia C.G. 4.
GIBSON COUNTY AUDITOR
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F Signatu a of County Auditor /ll / Date Signed (mont , day, ye r)
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4,*''.4 Social Security Administration
)'r «1WWW1 ., Benefit Verification Letter
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GREGORY ALLEN FRENCH
10209 E GLENDALE ST
OAKLAND CITY IN 47660-7786
You are entitled to monthly payments as a disabled individual.