Age_Krieg (2) -01 R.�
�,�.z� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
- "1 PROPERTY TAX BENEFITS
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State Form 43708(R13/4 15). `_�/P • . 2. 011 .
ass Prescribed by the Department of Local Government Finance V' 1\TT
2) Mobile Homes assessed under iC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months •
before March 31 of the year the deduction is to be effective.
•
See reverse side for additional instructions and qualifications.
• Type of benefit requested(p/eas eck all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(o ne contract uyer)/`� A �/\
o‘N
Is applicant the sole legs equ'able owner? If No,what is his/her exact share o int est? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No
If name on record is differe t than t of applicant,indicate below FIL ; t Do all joint tenants or tenants in common reside on the property?
0,..
:':Yes El No
Name of contract seller Has applicant owned or been buying the •roperty under recorded
JAN 0 3 2020 contract for at least one(1)year b ore- imng deduction?
Yes ❑ No
Address of contra t seller(number and street,city,state,and ZIP code) Ji� Is the property in question:
GIBSON COUNTY AUDITOR Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number/Legal description R cord number Page number
26-13 2\ V 0 T -o O 0. I Y1 --00 Li .
Does applicant reside on property?
Have you filed for any other deductions? If Yes,what deductions?`
XYes
El No h \,5
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur f appli nt Address of applicant (number and street,city'state,and ZIP code)
K.
�, 3-- E l 57.0S ). ,,i cst-Y):.7
S ure of authorized representative Address of authorized representative (number and street cite{state,and ZIP code) t fYJ-/(V,r,"ll I