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APPLICATION FOR CREDIT AGAINST PROPERTY
° TAXES FOR BLIND OR DISABLED PERSON
State Form 43710 (R15 / 7-25)
Prescribed by the Department of Local Government Finance
COUNTY
TOWNSHIP
YEAR
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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 95 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
SSA
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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 0No
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))?
eal Property ❑ Mobile Home (IC 6-1.1-7)
❑Yes 0140
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity?
Is the Property Used and Occupied Primarily for His/Her Residence?
Yes ❑ No
A
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'es ❑ No
Taxing District
Key Number / Legal Description
Record Number (contract)
Page Number (contract)
2-6S• �� -t?� b6�• ��� �®
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur of 1i n
Address of Applicant (number and street,city, and ZIP ccode)
jstate,
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Signature of Authorized Representative
Address of Authorized Representative (number and street, city, state, and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
61 o WW1,
Name of Contract Seller FILED
Taxing District G I _ APR 14 2026
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Key Number / Legal Description
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- ®� f l GIBSCN COUNTY AUDITOR
Signature of Cgunty Auditor n It Date Signed (month day, year)
Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Award
Office of. Central Operations
6401 Security Boulevard
Baltimore, Maryland 21235-6401
Date: March 22, 2026
BNC#: 26MS247J74032-HA
0000060 00000325 - 4 SP 2.440 0318M3MCS7FI T7 P
MICHAEL F WASSON
2698 N BENCHMARK DR
PRINCETON, IN 47670-8523
You are entitled to monthly disability benefits beginning April 2026.
The Date You Became Disabled
We found that you became disabled under our rules on November 1, 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 April 2026:
Your Benefits
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
April 2026 $2,540.90 Entitlement began
What The Railroad Retirement Board Will Do
The Railroad Retirement Board will make Social Security payments to you.
This is because you, your spouse, or the person on whose Social Security
record you filed worked for at least 10 years in the railroad industry or
worked at least 5 years in -the railroad industry after 1995.
Enclosure(s):
Pub 05-10077
Pub 05-10153
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