HomeMy WebLinkAboutDisabilty_Cochran APPLICATION FOR CREDIT AGAINST PROPERTY
COUNTY TOWNSHIP YEAR
TAXES FOR BLIND OR DISABLED PERSON
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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 qualifications.
Name of Applicant(owner or contract buyer) Telephone Number Email Address
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Is ApplicaQtjie Sole Legal or Equitable Owner? If No. What is the Applicant's Exact Share or Interest? If Owned 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
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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)
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C3L-1" FILED
e of Cont Seller -_
Taxing District F E B 1 2 2026
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Key Number 1 Legal Description
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c\Q - \'a_ \21 Q 1 _ Oa • C l -- GIBSON COUNTY AUDITOR
Signature of County Auditor Date Signed (month, day, year)
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Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Award !
Great Lakes Program Service Center
600 West Madison Street
Chicago Illinois 60661-2474
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Date: January 24, 2026
BNC#: 26MS372D37412=HA
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0000131 00012537 2'9P 1.030 0124M3MCS4P1 T88 P o
dur . SONYA L COCHRAN
• • 1033SRACEST
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PRINCETON, IN 47670-2728
You are entitled to monthly disability benefits beginning November 2025.
The Date You Became Disabled
We found that you became disabled under our rules on May 16, 2025.
To qualify for disability benefits, you must be disabled for five full calendar
months in a row. The first month you are entitled to benefits is
November 2025. - -- -- - — _-
What We Will Pay And When
• You will receive $1,546:00 for January 2026 around February 25, 2026.
i After that you will receive $1,546.00 on or about the fourth Wednesday
of each month. •
• New rules require you to receive your payments electronically, unless 'r•�
you get an exemption from the U.S. Department of the Treasury. Please
call Treasury 'at 1-888-224-2950 to see if you qualify for an exemption.
Your Benefits t
The following chart `shows your benefit amount(s) before any deductions or
rounding. The amount you actually receive(s) may differ from your full
benefit amount. When we figure how much to pay you, we must deduct
certain amounts, such as Medicare premiums. We must also round down to
the nearest dollar. ; .
Beginning Benefit •
Date - Amount Reason •
November 2025 , $1,504.60 Entitlement began
Enclosure(s):
Pub 05-10153
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