HomeMy WebLinkAboutDiability_SchwartzloseAPPLICATION
FOR CREDIT AGAINST PROPERTY COUNTY TOWNSHIP YEAR
TAXES FOR BLIND OR DISABLED PERSON
State Form 43710 (R15 / 7-25)
Prescribed by the Department of Local Govemment Finance
Instructions. To be filed in person or by mail with the county auditor of the county where the property /s 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 orcontract buyer) Telephone Number
Email Address
Is Applica 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
UD Yes ❑ No
If Name on Record Is Different than that of Applicant, Indicate Below:
Name of Contract Seller Address of Contract Seiler (numberand 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 El Mobile Home (IC 6-1.1-7) Is Applicant Disabled and Unable to Engage in A[]Yes [� No
ny Substantial Gainful Activity? Is the Property Used and Occupied Primarily for His/Her Residence?
es ❑ No
Taxing District es ❑ No
Key Number/ Legal Description Record Number (contract) Page Number
D�•A&-DoA-1gLpl* 1
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, ct ,state, and ZIP code)
Signatu of Authorized Rep sen live Address of Authorized Represents . e (number and street, city, state, and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS
Name of Applicant
n Date Filed (month, day, year)
c. 6.h Lt&jy low Ur 1
Name of C ntract SellerF"ILED
Taxing District ) APR 15
2026
Key
/Number / Legal Description
-oo®�"969— t)ie GIBSON COUNTYAU
DITOR
Signature of County Auditor r Date Signed (month, day, year)
a Le
SOCIAL SECURITY ADMINISTRATION
Date: April 18, 2023
BNC#: 23BC778D15075
REF: A
GARY C SCHWARTZLOSE JR
3034 N 150 W
PATOKA IN 47666-9020
You asked us for information from your record. The information that you
Z
requested is shown below. If you want anyone else to have this ini-ormation, y
may send them this letter.
Information About Current Social Security Benefits
Beginning December 2022, the full monthly
Social Security benefit before any deductions is ...... $ 1340.40
We deduct $164.90 for medical insurance. premiums each month.
(We must round down to the whole dollar.)
Social Security benefits for a given month are paid the following month, (F(
example, Social Security benefits for Marc.h are paid in April.)
Your Social Security benefits are paid on or about the fourth Wednesday of
each month.
Other Important Info t
rmation
GARY SCHWARTZLOSE JR RECEIVES 8OCIAL.SECUIRTY DISABILITY. HIS DATE OF
ENTITLEMENT IS 11/2016.
SUSPECT SOCIAL SECURITY FRAUD?
Please visit http://Oig.ssa.gov/r or call the Inspector General's Fraud
Hotline at 1-800-2.69-0271 (TTY 1-866-501-2101).,
IF YOU HAVE QUESTIONS
Need more help?
1. Visit www.ssa.gov for fast, s .. imple, and secure online service.
2. Call us at 1-800-772-1213, weekdays from 8:00 am to 7:00 pm, if you
are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention
this letter when you call.