Age_Dyson •'+a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BFDIEFITS C
.c - State Form 43708 1-20) ,.1�,-/�\ / -/0 `-�'
�+\�'•;-� �'" Prescribed a Department of Local Gover ment Finance `...J�j' U
o4'11 .c' kcile File Mark
Information contained' this docu ent is C NF Ar pursuant to IC .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
-- � / �
Type of benefit requested(Please check`all that apply.) !�"
�vver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or tract uyer)
MPhOMga. 3'�rl
l
Is applicant t le legal a uita owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es ❑NO
If name on record is differ t t n 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 contra r
at least one(1)year before claiming deduction? ❑Yes O
A ress of contract seller(number and street,city,state,and ZIP code) Is h property in question:
Real property ❑Mobile home(/C 6-1-1-
Taxing district Key number/Legal description Record number Page number
26 12-OJ- �4 -Y . y2C-Oz8
Does applicant reside on p pe ? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑No [counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
esproperty)for the Over
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
❑Yes ❑No
Have you filed for deductions in any other ou y? If Yes,what county?
❑Yes No
I/We certify under penalty of perju th the above and foregoing information is true and correct.
Si nature applicant Date(month,day,year)
)( Address of applic fit (number an street,cit t te,and ode)
ignature of authorized representative Date(month,day,year)
Address of authorized/'� representative (number and street,city,state,and ZIP code)
Si alum of cuar, u , r� Dat-�fo 1,,dpy y !� h
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FEB 1 7 2022
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer