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""- APPLICATION FOR CREDIT AGAINST PROPERTY
`- TAXES FOR BLIND OR DISABLED PERSON COUNTY TOWNSHIP YEAR
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'� State Form 43710 (R15! 7-25) C:)
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--_!i _i. `` Prescribed by the Department of Local Government Finance L> rqQn4 t L, [p
Instructions: To be filed in person or by mail with the county auditor of the county where the property is located. �_--1
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)
with Someone Other than Spouse, Indicate with Whom
es ❑ No
If Name on Record is Different than that of Applicant, Indicate Below:
Name of Contract Seller Address of Contract Seler(number and street, city, state, and ZIP code)
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Is the Property in Question: Is Applicant Blind (as defined in IC 12-7-2-21(1))?
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eal Property ❑ Mobile Home (IC 6-1.1-7) ❑Yes El- o
Is Applicant Disabled,pd Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Her Residence?
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Yes ❑ No
Signature ppli nt Address of Applicant (number and street, city, state, and ZIP code) t (\j:J
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�gnature f uthozed Representative -. - Address of Authorized Representative (number and sweet, 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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1 r\ c- . Aar Q ei--is FI.LED
Name of Contract Seller
Taxing District F E B 1 7 202C
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Key Number/ Legal Description
C) V• C:) . ) �IBSON COUN AUDITOR
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Signature of County Auditor Date Signed (month, day, year)
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ii SOCIAL SECURITY ADMINISTRATION
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USA-
Devin Samuel Harvey
2
999S675W
Owensville, IN 47665-9129
Notice of.Decision • Fully Favorable