Age_Cottingham oizT.F, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
s . PROPERTY TAX BENEFITS
�'v LI State Form 43708(R15/1-20) ?�2A
�y`tir .
�eie 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.
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 payable.
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply.) `
®Over 65 Deduction from Assessed Valuation [kOver 65 Circuit Breaker Credit
Name applicant(owner or cons ct 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.
JYes ❑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?
❑Yes El No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
ill Yes No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxin di trict r-
1Yes ❑No Ai. S,
Have you filed for deductions in any other county? If Yes,what county?
❑Yes 7.plo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
•
` ` Signal a of applicant Date(month,day,year)
AlAdds of applicant (number nd street,city, ,and ZIP code)
3a, Ii wA / t _- Lena 7 b
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signal a of County Auditor Date(month,day,year)
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FILE :
NOV 16 2020
40:coi-----
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer