HomeMy WebLinkAboutDisability_OrrAPPLICATION FOR CREDIT AGAINST PROPERTY
r TAXES FOR BLIND OR DISABLED PERSON
Stale Form 43710 (R15 / 7-25)
's Prescribed by the Department of Local Government Finance
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
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
es ❑ 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 Question:
Is Applicant Blind (as defined in IC 12-7-2-21(1))?
C]�al Property ❑ Mobile Home (IC 6-1.1-7)
❑Yes o
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
es ❑ No
Taxing District
Key Number/ Legal Description
Record Number (contract)
Page Number (contract)
4 �5. H coo - c
We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature o plicant
Address of Applican`t (numberand street, city, state, and ZIP code)
c
S ature of Authorized Representa a
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)
FILL
Name of Contract Seller
A U G 2 6 2026
Taxing District
Key Number /Legal Description
.e ud
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GIBBON COUNTY AUDITOR
gnature of County Auditor
Date Signed (month, day, year)
I
02/J S M4
Social Security Administration
Retirement, Survivors, and Disability Insurance
Notice of Award
Jill 111111111111111 oilii11111111
0000017 4 3 SP 1.320 0126MECTR4PD T41 P
LISA Y ORR
324 BRETr LANE
SPENCERVILLE OH 45887-1104
Great Lakes Program
Service Center
600 West Madison Street
Chicago, Illinois 60661-2474
Date: January 31, 2026
BNC#: 26M1404J77080-A
We are writing to let you know that you are entitled to monthly
disability benefits from Social Security beginning August 2022.
After further review, we found that you were never sent your
Notice of Award for your disability entitlement. This notice is
to provide you with the information that should have been sent
to you in May 2025.
Your Benefits
The - fal-lowing- wrchart-- shos your -benefit amount s before' -an - _
y
deducti,ons or rounding. The amount you actually receive may
differ from your full benefit amount. When we figure how much
to pay you, we must deduct certain amounts, such as Medicare
premiums and worker's compensation offset. We must also round
down to the nearest dollar.
Beginning
Date
August 2022
December 2022
December 2023
December 2024
December 2025
What We Will Pay
Benefit Reason
Amount
$ 2,205.80
Entitlement began
$ 2,397.70
Cost of living
adjustment
$ 2,474.40
Cost of living
adjustment
$ 2,536.20
Cost of living
adjustment
$ 2,607.20
Cost of living
adjustment
We pay Social Security benefits for a given month in the next
month. For example, we pay Social Security benefits for March
in April.
• The next check you receive will be for $2,384.80, which is
the money you are due through January 2026.
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