HomeMy WebLinkAboutDisability_HenningAPPLICATION FOR CREDIT AGAINST PROPERTY
a; TAXES FOR BLIND OR DISABLED PERSON.
' State Form 43710 (R1517-25)
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 riled 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 (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 ❑ Mobile Home (IC 6-1.1-7)
❑Yes Q No
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
[Yes ❑ No
Taxing District
Key Number / Legal Description
Record Number (contract)
Page Number (contract)
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I/We certify under penalty of peijury that the above and foregoing information is true and correct.
Signature of Applicant
Address of Applicant (number and street, city, state, and ZIP code)
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nature of Autho ed R resentative
Address of Authorized Representative (number and street, city, state, and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND I DISABLED PERSONS
Name of Applicant
Date Filed (month, a , tL
Name of Contract Seller
MAY 12 2026 R(-
Taxing District
GIBSON COUNTY AUDITOR
Key Number/ Legal Description
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Signature of County Auditor
Date Signed (month, day, year)
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Social Security Administration
Retirement, Survivors and Disability Insurance
Notice of Award
Mid -America Program Service Center
601 East Twelfth Street
Kansas City, Missouri 64106-2817
Date: February 24, 2020
BNC#: 20MS75OF84511-HA
0000458 00021343 3 MB 0.439 0220M3MCS6PI T148 P16
LISA M HENNING
674 W STATE ROAD 168
FORT BRANCH, IN 47648-8201
You are entitled to monthly disability benefits beginning June 2018.
The Date You Became Disabled
We found that you became disabled under our rules on August 11, 2016.
By law, we can pay benefits no earlier than 12 months before the month of
filing. Since you filed for benefits on June 17, 2019, monthly payments will
beginJune 201 °. _
What We Will Pay And When
We pay Social Security benefits for a given month in the next month. For
example, Social Security benefits for March are paid in April.
• You will receive $16,345.50 around February 25, 2020.
*•r •,
• This is the, money you are due for June 2018 through January 2020.
• . Your next payment of $1,114.00, which is for February 2020, will be
received on or about the third Wednesday of March 2020.
• After that you will receive $1,114.00 on or about the third Wednesday of
each month.
• Later in this letter, we will show you how we figured these amounts.
• New rules require you to receive your payments electronically, unless
you get an exemption from the U.S. Department of the Treasury. Please
call Treasury at 1-888-224-2950 to see if you qualify for an exemption.
Enclosure(s):
Pub 05-10153
Pub 70-10281
Return Envelope
Form CMS-2690
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