HomeMy WebLinkAboutDisabilty_Young 4,4..q., APPLICATION FOR CREDIT AGAINST PROPERTY COUNTY TOWNSHIP YEAR
- .-,: �i TAXES FOR BLIND OR DISABLED PERSON .
State Form 43710 (R15 17-25)
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f Prescribed by the Department of Local Government Finance bl b ! LCI-- 11\01%1/4...e a--)1 1Q
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.
Nme of Appli :r or contract buyer)
with Someone Other than Spouse, Indicate with Whom
Yes ❑ 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))?
Real Property ElMobile Home (IC 6-1.1-7) ❑Yes N" o
D
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Hej Residence?
lac:: ❑ No Ej'(ees ❑ No
Taxing District Key Number/Legal Description Record Number (contract) Page Number(contract)
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IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur o1 Applicant Address of Applicant (number and street, city, state, and ZIP code)
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Signature of Authorize. Representa1 Address of Authorized Representative (number and street, city, state, and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND t DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
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Name of Contract Sel r
F EB 13 2026
Taxing District c
KeyP - F (AL (- , _3Q-Ls.__,-t,._ ,_____is
Number/Legal Description . •lam
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DW -. \\.'" OM DOC - GIBBON COUNTY AUpITOR
Signature of County Auditor Date Signed (-month, day, year)
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A�%. Social Security Administration
1jul11 o Benefit Verification Letter
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TIMOTHY ALLAN YOUNG
6602 W STATE ROAD 64
PRINCETON IN 47670-8416
You are entitled to monthly disability benefits.
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