HomeMy WebLinkAboutDisability_RolandAPPLICATION FOR CREDIT AGAINST PROPERTY
TAXES FOR BLIND OR DISABLED PERSON
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f State Form 43710 (R15 / 7-25)
a Prescribed by the Department of Local Government Finance
TOWNSHIP
YEAR
�CCOUNTY
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
(Sla��SH-14q
--
Is Applicant the Sole Legal or Equitable Owner?
ED Yes ❑ No
If No, What is the Applicant's Exact Share or Interest?
If Owned with Someone Other than Spouse, Indicate with Whom
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:
4 Real Property ❑ Mobile Home (IC 6-1.1-7)
Is Applicant Blind (as defined in IC 12-7-2-21(1))?
❑Yes
Is Applicant Disabled Unable to Engage in Any Substantial Gainful Activity?
19 res ❑ No
Is the Property Used and Occupied Primarily for His/Her Residence?
es ❑ No
Taxing District
Key Number / Legal Description
Record Number (contract)
Page Number (contract)
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)
Signature of Au rued Representative
Address of Authorized Representative (number and street, city, stat , and ZIP code)
RECEIPT FOR APPLICATION FOR CREDIT FOR BLIND / DISABLED PERSONS
Name of Applicant Date Filed (month, day, year)
eA 01o__Y-\C� .
Name of Contract SellerFILIA-i
Taxing District
Key Number I Legal Description T
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Signature oSignature o C�uditor
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FEB 2 6 2026
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Date Signed (month, day, year)
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Sicial `security Administration
. .Retirement, Survivors and _ Disability Insurance
Important Information
Mid -America. Program Service Center
601 EastTwelfth Street
Kansas City, Missouri 64106-2817
Date: December 30, 2025
- BNC#: 25T2261J29983-1-1-A
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0052948 00369067 1 AB 0.641 1223MInR6.PN T1077 P42
MICHAEL J ROLAND. DAD
330. DALE ST ;..
OAKLAND CITY IN 476604728'
We are writing to you about- .your Social Security benefits.
What You Should -Know
Your Medicare Part A (hospital insui'ance)':.and Part-,B (medical insurance)
start February 2026. J
s. .
What We Will Pay And When
We pay Sc,ciai Securi'ty�benefits far a given month ' in tfe next month. For
example, Social Security benefits for March are paid in April.
e You will receive $2,085.00 for January 2026 around February 3, 2026.
e' After that you will receive $2,085.00 on or about the third of each
month.
Information A. out Medicare
Your monthly "premium for Medicare Part B (medical insurance) is $202.90
beginning February 2026.
IMPORTANT: A Medicare law requires. some' hi her income persons to pay
higher premiums. The law applies to premiums for Medicare Part B (Medical
Insurance), prescription drug coverage, and Medicare Part B
Immunosuppressive Drug coverage. The law generally affects individuals with
in comes, higher than $109,000' and couples w.ith1ncomes higher.than $218,000.
We will contact the Internal Revenue Service *to: get information about your
income. If we decide that you have to pay...higher premiums, we will send a
letter explaining our decision. The higher amount will be effective
February 2026. For more information, please visit www.ssa.gov on the
internet or call us.to .1 :£ree at 1-800-772-1213 (TTY 17800-325-0778).
We deduct: Medicare medical insurance ("art B) premiums 1 month in
advance.
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