HomeMy WebLinkAboutDisabilty_Cochran APPLICATION FOR CREDIT AGAINST PROPERTY
COUNTY TOWNSHIP YEAR
TAXES FOR BLIND OR DISABLED PERSON
J
State Form 43710 (R15 / 7-25) I►ih.-. , Prescribed by the Department of Local Government Finance 1 IQ�\ � r(zl l"\(�QMI a"ln
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
with Someone Other than Spouse, Indicate with Whom
Dyes ❑ No
If Name on Record is Different than that of Applicant. Indicate Below:
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))?
eat Property ❑ Mobile Home (IC 6-1.1-7) Yes Utcrirr
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? • Is the Property Used and Occupied Pnmarily for His/Her Residence?
[2.4;-; ❑ No 'Yes ❑ No
Taxing District Key Number/ Legal Description Record Number (contract) Page Number (contract)
_.-1/4NCC.-A-C'EM ; 0 (D. C .
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) U\--L, w V
X Y‘41 ep-diw\tv.0\3•A__ ta
Signature of ALityrized Representative Address of Authonzed 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, day, year)
ej)k.
C3L-1" FILED
e of Cont Seller -_
Taxing District F E B 1 2 2026
P • `
Key Number 1 Legal Description
(ti24- 4a,1J a. rax,�Za)
c\Q - \'a_ \21 Q 1 _ Oa • C l -- GIBSON COUNTY AUDITOR
Signature of County Auditor Date Signed (month, day, year)
-
•
•
lulllellllhlelllrrull.lerereprlllrrlpilllleerreillerrrrtllrel
0000131 00012537 2'9P 1.030 0124M3MCS4P1 T88 P o
dur . SONYA L COCHRAN
• • 1033SRACEST
f.:c . o
PRINCETON, IN 47670-2728
You are entitled to monthly disability benefits beginning November 2025.