Age_Barr ,,•.FrAr.a, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
yii \' PROPERTY TAX BENEFITS
71 Vie
!� State Form 43708(R15/1-20) ("�� Z
Prescribed by the Department of Local Government Finance O I/A QQ /L V
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 at apply.)
Over 65 Deduction
(1 nl,�
L/1/1 l,-/2 a,�// J nt or
Is applicant the sole legal or equi a owner? If No,what is his/her exact share or interest? If owned th joint tenant or to nt in common,indicate with whom.
es ❑No L-L'r2/2--e-
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 ract for
at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the erty in question:
eal property ❑Mobile home(IC 6-1-1-7)
Taxing di ct �/ Key number/Legal description �/ Record number Page number
�1r��� 2/ -20- /i - A/oo - Cni. D,.�2 -
Does applicant reside on property? Assessed value of the property as of current year assess nt date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑Yes ❑No (counting just the homestead site]for the Over 65 Circuit Brea r Credit received before January 1,2020.and$199,999 fall Indiana real
properly]fort ver
$
individual's spouse.)See reverse for details.
Have you filed for any other deductio If Yes,wh t deductions?
es ❑No A '/E'7�j
Have you filed for deductions in any other count If Yes,what county?
❑Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
ignatur of / Date(month,day,year)
beigep
> Address applicant (numbs, reef,city,state,and ode)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signal e of County Auditor ef Date(month,dayyea Z Z
/1,i,d7 r il/Q):1 -tri.5._____s7
FILED
APR 0 72022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ' ' e-e e Ay.45,,;rt,,)
GIBSON COUNTY AUDITOR