Age_Knight ,.._ APPLICATION FOR SENIOR CITIZEN TOUNTY TOWNSHIP YEAR
% > PROPERTY TAX BENEFITS
_q
5\ :1 State Form 43708(R15/1-20) Q,/� 00 �0 Z
i- Prescribed by the Department of Local Government Finance G - \ l G _
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 al at apply.)
ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant
y/(o'wner or contract buyer) /A r/ - • l
LIT)
Is applicant(�tthhee sst/1e legal to Here what is hiiiss//h exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the operty?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract f
at least one(1)year before claiming deduction?
❑Yes No
Address of contract seller(number and street,city,state,and ZIP code) Is the erty in question:
Real property ❑Mobile home(/C 6-1-1-7)
Taxing di ict Key number/Legal description Record number Page number
� _ 2&-/3-1 y- i 02- 70/-X/z-6:10A-il
Does applicant reside o rop y? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Yes ❑No (counting just the homestead site)for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property]for the Over 65
$
Have you filed for any other deductio If Yes,wh t deductions?
es El No � V ✓277..--
Have you filed for deductions in any other county? es,what county?
❑Yes O
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
` Signature of applicant� - .I Date(month,day,year)
X s /o ,� �
Address of applic (number a d street, Q' state,and ZIP code) L1 /y -
Signature of authorized representative / Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature unty A ditor Date(month,day,year)
! � 7 --- _ 5-/0 - o� 2.---
FILEDA
ck OA (sJ 1-1/4_
MAY 1 0 2022/
t'l� /r
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer / a
GIBSON COUNTY AUDITOR