HomeMy WebLinkAboutDisability_Millerg�. APPLICATION FOR CREDIT AGAINST PROPERTY
a 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.
INC
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.
N
Name of Applicant (owner or contract buyer)
Teelle Number
Email Address
LC r Q T"l . e
(phone
O 1 l
Is Applicant the Sole Legal orr Equitable Owner?
If No, What is the Applicant's Exact Share or Interest?
If Owned with Someone Other than Spouse, Indicate with Whom
E] ves ❑ No
If Name on Record is Different than that of Applicant, Indicate Below:
Name of Contract Seller
Address of Contract Seller (numberand sheet 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 LJ we
Is Applicant Disabled and Unable to Engage in Any Substantial Gainful Activity?
Is the Property Used and Occupied Primarily for His/Her Residence?
01' 1s ❑ No
es ❑ No
Taxing District
Key Number / Legal Description
Record Number (contract)
Page Number (contract)
I/We certify under penalty of perjury at the above and foregoing information is true and correct.
Signat re of Applicant
Address of Applicant (number and street, city, state, andZIPcode)
$:ighafure 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 (mo y e
Ucro—
C C T 01 2026
Name of Contract Seller
�
Taxing District
1
7hi C fi. 1�U 4
GIBSON COUNTY AUDITOR
Key Number/ Legal Description
Signature of County Auditor
Date Signed (month, day, year)
U
ous� SOCIAL SECURITY ADMINISTRATION
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Lora A Miller
412 E Harrison St
Oakland City, IN 47660
Office of Hearings Operations
OLD POST OFC, 3RD FL
100 N.W. SECOND ST.
EVANSVILLE, IN 47708-9923
Date: August 26, 2026
Notice of Decision — Fully Favorable
I carefully reviewed the facts of your case and made the enclosed fully favorable decision.
Please react this notice and my decision.
When Will You Get Paid
Anothcr office will process my decision and decide if you meet the non -disability requirements
for Supplemental Security Income payments. That office may ask you for more information.
You should receive payment in 40-60 days of the date of this notice. However, some cases may
vary. If you do not hear anything within 60 days of the date of this notice, please contact your
local office. The contact information for your local office is at the end of this notice.
If You Disagree With My Decision
If you disagree with my decision, you may file an appeal with the Appeals Council.
How To File An Appeal
To file an appeal you or your representative must ask in writing that the Appeals Council review
my decision. The preferred method for filing your appeal is by using our secure online process
available at https://www.ssa.gov/benefits/disability/appeal.html.
You may also use our Request for Review form (HA-520) or write a letter. The form is available
at https://www.ssa.gov/fonns/ha-520.html. Please write the Social Security number associated
with this case on any appeal you file. You may call (800) 772-1213 with questions.
Please send your request to:
Fonn HA-L76 (07-2024)
Suspect Social Security Fraud?
Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline
at 1-800-269-0271 (TTY 1-866-501-2101).
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