Age_Dienhart -_. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
: ��� PROPERTY TAX BENEFITS f�
�\� iP State Form 43708(R15/1-20) / `�wC—
File Mark il
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. FILED
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. g
i
1
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by thflivi g
January 5 of the calendar year in which the property taxes are first due and payable. lfTT v 2 2022
See reverse side for additional instructions and qualifications. i
GIBSON CZ�y` «cJ
Type of benefit requested(Please check all that apply) DITpR
3SCOver 65 Deduction from Assessed V���11lyyyation Over 65 Circuit Breaker Credit
Name /li ant(owner or contract byyer)n��7L/ . /�� • �
Is applicant(thheeessoollleelleggalalloom e(gquu�iittable�lown[[err?'' If Na�llvhat is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
-*Qes ❑No VVV
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 ❑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? ❑Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) s t property in question:
a
eal property ❑Mobile home(/C 6-1-1-7)
-T ng istri t Key number a),Qescription Record number Page number
f.
Does applicant reside on propert ? A eased value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑ o (counting just the homestead
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions?f If Yes,ha deductions?
h�Ll Yes ❑No s
Have you filed for deductions in any other county? If Yes,what county?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si aIt�Ye of pplicant Date(month,day,year)
_V O � V LP n -F-
Address of a I nt (number and street,city,state,and ZIP code)
3 2/ V 1 i& < k ,S-I- O4Ck(a ncQ,�` i i:i (-f C.04.0o
Signature of authorized representative Date(month,day,year)
Address of authorized representative er and street,city,state,and ZIP code)
Signa7f County Audit Date(month,day,year)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer