Age_Downs �:M., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
al �. State Form 43708(R15/1-20) //� a a I
.y ,e,. +'' Prescribed by the Department of Local Government Finance a,.—S O 1) l,/ (� ,3
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. / 1 — 0 --/ - a o (-p 0 1 1 ,-7- ^0��
Type of benefit requested(P/ease check all that apply.) IV_ C/ll
IZI Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applica er-Ur cdnfr'
Robert Sylvia J Downs
Is applicant the sole legal or equi a•e owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
®Yes ❑No If name on record is different than that of applicant,indiiFeTT
l�v.L1) Do all joint tenants or tenants in common reside on the property?
11 ������,,���,,,JJJJ// Q.IYes E]No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
tow 3 0 2021 at least one(1)year before claiming deduction? 121 Yes El 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)
Taxing district Ke�y �dalftN6rc� Record number Page number
028 2�It$2d3Yc2Dtreit P14T748
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 ❑N O n auntnyl lbr tM Over
0Yes ❑No Hstead
Have you filed for deductions in any other county? If Yes,what county?
El Yes WI No
I/We c under penalty of perjury that t above and foregoing information is true and correct.
�� t
Signature f p lira t t Date(\Ontq,day,ye�r)
\ ,,, `do--�,�- • \` J�7�,✓, �Z
ss o applicant (num6erl'an street,city,st and ZIP code)
210 E Spruce SR, P'ton, IN 4i /0
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city state,and ZIP code) ({
Signature of C{gtint)t A�ditpr Date(mont day,,yea 2-
FI04.17Z
LED
fXf' 1 NOV 3 0 2021
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer 7 n,e C2-4,, `6i; f
GIBSON COUNTY AUDITOR