HomeMy WebLinkAboutDisabilty_Harvey •
""- 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) Telephone Number Email Address
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Is Applicant the Sole L al or Equitable Owner; If No. What is the Applicant's Exact Share or Interest? If Owned 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 es ❑ No
Taxing District ' Key Number/Legal Description Record Number(contract) Page Number (contract)
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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-NI
‘i 111 Office of Hearings Operations
ost,i
Old Post Ole, 3rd Fl
jI00 N.W. Second St.
rEvansville, IN 47708-9923
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Date: October 10, 2024
Devin Samuel Harvey
2 I
999S675W
Owensville, IN 47665-9129
Notice of.Decision • Fully Favorable
I carefully reviewed the facts of your case and made the enclosed fully favorable decision.
Please read this notice and my decision.
When Will You Get Paid
Another office will process my decision. That office may ask you for more information. You
should receive payment in 40-60 days of the date of this notice. However, some cases may vary.
if you do not hear anything within 60 days of the date of this notice, please contact your local
office. The contact information for your local office is at the end of this notice.
11' You Disagree With My Decision
If you disagree with my decision, you or your representative may submit written exceptions to
the Appeals Council. "Written exceptions" are your statements explaining why you disagree
with my decision. Please write the Social Security number associated with this case on any
written exceptions you send.
Please send your written exceptions to:
Social Security Administration
Office of Appellate Operations
6401 Security Blvd
Baltimore, MD 21235-6401
Or Fax: (833) 763-0406
If you need help, you may tile in person at any Social Security or hearing office.
Form HA-T_76 (07-2024)
Suspect Social Security Fraud:'
Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline
at 1-800-269-0271 (TTY 1-866-SO 1-2101 ).
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