Age_Gray •
d, es APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7' iri PROPERTY TAX BENEFITS
igy=
State Form 43708(R13/4-15)
lee Prescribed by the Department of Local Government Finance �� •
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
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INSTRUCTIONS:To be filed in person or by mail with the CountyAuditor of the county where the property is located. •
Filing Dates: 1) Real Property:Form must be completed and signed.by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured
ame of applicant o frac yer)
%Nib 4 al C ` •-,
Is applicant the al or equitable owner? Ii No what is ct share or interest? If owned with joint tenant or tenant in common,
L E D indicate with whom
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
FEB 19 2020 Yes ❑ No
Name of contract seller Has applicant owned or been buying e property under recorded
contract for at least one(1)year be r !aiming deduction?
GIBSON COUNTY Yes ❑ No
Address of tract seller(number and street city, fate,and ZIP code) A U D ITO Ris the pe in question:
` .0 ,t 001 1 (�10A1 L&6 a Real property ❑ Mobile home(IC 6-1-1-7) •
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Taxing district--Y 7 Key number/Legal description Rec number Page number
?26 -04-24-300 - 000. 139-020
Does'applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed'
$162,430 for Over 65 Deduction or$159,999[counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
YesSee reverse for details.
Is the applicant 65 years of age or more on December of the year
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. Adjusted gross income of applica t,ap licant and spouse,or
Yes El No N
4c
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes No ,
I/We certify under penalty of perjury that the ab ve a d foregoing information is true and correct. '
Sig ature of applicant A ress f applicant (number and street,city,state nd ZIP code ,...4._ c)6"
Q5J\C‘. ,..53,A.AitiV
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Signature of authorized rep entative Address of authorized representative (numberind street,city,state,and ZIP code)
)A6.9.A.9...).Ҥ-3 el --ti II 1 13 sow