Age_Poling ,--Az., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
1i PROPERTY TAX BENEFITS
State Form 43708(R15/1-20)
, .. . Prescribed by the Department of Local Government Finance T T
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. l �J
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. APR )y 1 2022
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.
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See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benefit requested(Please check all that apply.)
0 Over 65 Deduction from Assessed Valuation 0 Over 65 Circuit Breaker Credit
Name of applica caner or contract bu
Donald Debra G. Poling )
Is applicant the s ie liter ui aqui.adtC wner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
0Yes ❑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?
0Yes ❑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? 0 Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
0 Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Princeton 26-12-07-400-001.006-028
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
0 Yes ❑No (counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
❑Yes Jo Homestead and Mortgage
Have you filed for deductions in any other county? If Yes,what county?
❑Yes 0No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Date(month,day,year)
4/11/2022
Address of applicant (number and street,city,state,and ZIP code)
909 S Jefferson, Princeton, IN
sigruzatwizr reporpsen,tive Date(month,day,year)
Address of authorized repres tative ( mber a d street,ci ,state,and Zl code)
Signet a of%my A itor r / Date(month ay,year)
FILED ,
e� tAPR 11'2022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer hec aG/ a-141. -4irtd.)
GIBSON COUNTY AUDITOR