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Age_Martin 4EErTe, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR `� ;;� PROPERTY TAX BENEFITS 1 al'\� '! State Form 43708(R15/1-20) ��n e SO Prescribed by the Department of Local Government Finance ` i . n^ Ora 2 o r V \(QV i 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 Name of applicant(owner or contract uyer) 1 I 1 1 O l n ���� YYYYYY • Is applicant the sole legal or equitable owner? If No,what is his/her exact sharell or interest? If owned with joint tenant or tenant in common,indicate with whom. Yes ❑No . If name on record is different th n that of applicant,indicate-below;. - , ,_ . _ Do joint tenants or tenants in common reside n he property? _ : . es ❑No Name of contract seller Has applicant owned or been buying the property under r d contract for at least one(1)year before claiming deduction? es ❑No Address of contract seller(number and street,city,state,and ZIP code) Is roperty in question: al property ❑Mobile home(/C 6-1-1-7) Taxing district 024 Key tuber/Legal description ZL-12-1 'V-301-00) .9-3 27-40 Record number Page number 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 III Yes ❑NO [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real property)for the Over $ individual's spouse.)See reverse for details. Have you filed for any other de ons? If_Yies,who- t de l io s Yes III NO fYe,S atcoun ��` Have you filed for deductions in any other county? If Yes,what county? ❑Yes IXNo INVe certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant Date(mont da,year) Address of applica t (number and street,city,state and ZIP code) 1 425- ` iyit_ 1Yt.— Pl-'hyi- 3 `'11-61-o Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Ir" Signature of •�'my Au i r FI ' •j' Date(month,day,year) SEP 212020 RECEIVED • - -.. SEP 2 1 2019 GIBSON COUNTY AUDITOR - DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer