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Age_Butcher e rrl. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR " % k, PROPERTY TAX BENEFITS x'\'i33;1 State Form 43708(R15/1-20) ;y' Prescribed by the Department of Local Government Finance G't bso(1 C,Q111tt1A,t File Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. 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 and signed by December 31 and filed with the county auditor or postmarked by the following January 5 of the calendar year in which the property taxes are first due and Name of applicant(owner or contract buyer) Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. Rr s ❑No If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside onnthb property? ®Yes ❑No Name of contract seller Has applicant owned or been buying the property under recorded contract for N at least one(1)year before claiming deduction? ��!' ❑No p1 es Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: eal property ❑Mobile home(IC 6-1-1-7) Taxing di tract Key number I Legal description Record number Page number Q ,k, b a,_ a u- lam,- - Li .... t -ooc�, Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 ❑Yes ❑No [counting just the homestead site]for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real property)for the Over Have you riled for any other deducti ns? If Yes,whatuctions? MYes ❑No , Have you filed for deductions in any other county? If Yes,what county? ❑Yes '1O I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant ' • Date(month,day,year) V �? W.t 1 S _ �. -CD 3 _ Address of applicant (number and street,city,state,and ZIP code) -ems �'V. • v-r i Q QLA a- 01 ( . \4—1 \ o Signature of authorized representative Dale(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signature of County Auditor ' A� r 0 Date(mont ,6a ye 2_3. VlJ 1 ,S 3 FILED ,. MAR 6 2023al N� DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer � GIBBON COUNTY AUDITOR "