HomeMy WebLinkAboutDisabilty_Bradfield `� ' > APPLICATION FOR CREDIT AGAINST PROPERTY
' COUNTY TOWNSHIP YEAR
l'7t TAXES FOR
a► �� �� BLIND OR DISABLED PERSON
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State Form 43710(R1517.25)
Prescribed by the Department of Local Government Finance
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Instructions: To be tiled in person or by mail with the county auditor of the county where the property is loca :
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. 2 ,_
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Name of Applicant (owner or contract buyer) Telephone Number Email Address
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Is Applicant the Sole Leg I o Equit e Owner? If No, What is the Applicant's Exact r Interest? If Owned with Someone Other than Spouse, Indicate with Whom
Yes EjNo
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If Name on Record is Differ t than that of Applicant, Indicate Below:
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Name of Contract Seller Address of Contract Sever�numberand strut, ity, Late, and ZIP code)
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Is the Property in Question: tv. ant Blind (as defined in IC 12-7-2-21(1))? j &
eal Property Mobile Home (IC 6-1,1-7
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Is Applicant isabl and Unable to Engage in Any Substantial Gainful Activity? Is the Prope_ 11/4_141. y4 .nd Occupied Pnmarily}follHislHer Reside ce?
Yes ONo ,T) Yes a No
Taxing District Key Number I Legal Description Record Number(contract) Page Number(contract)
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INe certify under penalty of perjury that the above and foregoing information is true and correct,
S. ature of Applicant2 Address of Applicant (number and st et, city, state, and ZIP code)
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ignature of Authorized Representative Address of Authorized Representative (number and street, city, state, and ZIP code)
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Notice of Award
Cis JAMES E BRADF i ELD
2166 S 750 E
FRANCISCO IN 47649-9052
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W
e are writing to let you know that you are entitled to monthly
disability benefits from Social Security beginning March 2018 . 5