HomeMy WebLinkAboutDisabilty_Sauer "'' APPLICATION FOR CREDIT AGAINST PROPERTY
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TAXES FOR BLIND OR DISABLED PERSON
State Form 43710 (R15/7-25) •
a Prescribed by the Department of Local Government Finance
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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 Applicant the 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
❑ 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 Que Is Applicant Blind (as defined in IC 12-7-2-21(1))?
Real Property ❑ Mobile Home (IC 6-1.1-7) ❑Yes {�d6"
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Her Residence?
Qees ❑ No ❑-ems ❑ No
Taxing District Key Number I 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 of Applicant Address of Applicant(number and street, city, state, and ZIP code) -I„
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Signature of Authorized Representative --Address of Authorized Representative (number and stree, city, state, and ZIP code)
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RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
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Name of Contract Seller FILED
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Taxing District MAR 2 3 2026
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Key Number/Legal Description (th. /2414L a plia-zLZ . '�4/�
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Signature of County Auditor Date Signed (month, day, year)
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Social •
Securit
Y Administration .:
RetirementSurvivoiis andNotice of Award Ilisurarice
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Great Lakes Program Service Center
600 West Madison Street
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Chicago, IIlinois 60661-24747.3
Date: March 8, 2013 �'
,Ilflf'tf� tfll�l ►tf �„� IIf,tlllllf� lf ll 11 ► r Claim Number:III I I 317-64-244.3HA
001443 2 MB 0.405 0019 LTR M08 PC4 0304
.� DALE A SAUER
7306 MALLARD POINTE
EVANSVILLE, IN 47711-7235 �'
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You are entitled to monthly disabilit benefits
� beginning December 2012.
What We Will PayAnd d When
• You will receive $4,353.00 around March 14, 2013.
• This is the money you are due for December 2012 through February
a g 2013.
• Your next
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of ,hi
received on or about r$1'` F1.:04; u �ti���zs Tor -1�,arch�",�(�13 Sri__
the third Wednesday of April 2013. , !� be
• After that you will receive $1,451.00 o each month. nor about the third Wednesday of
• These and any future a
yments know if will go to the financial institution o
u
selected. Please let us
you ch an e
can send you letters directly. g your mailing address, so we
Mama
• The day of the month you receiveyour payments depends on your date �.
Other Social Security Benefits _..
The benefit described in this letter is
Social Security. If you think that otthe only one you can receive from
Social Security benefit in the future, tonight qualify for another kind of
application. Y u will have to file another
Enclosure(s):
Pub 05-10153
Pub 05-10058
C See Next P
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