Age_McIntyer APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�%* 4e PROPERTY TAX BENEFITS
a\ �P State Form 43708(R15/1-20) /A• //�J
`,• Prescribed by the Department of Local Government Finance 1 .. t b� t,P�(1CG' Z.`� Z-Z
�J 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
II-Over 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the gal or equi ble owner? TMo.what is Q er exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Wes ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside�on�t e property?
1'Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded ntract for
1--- -� \V'(> at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the pr rty in question:
eat property ❑Mobile home(IC 6-1-1-7)
Taxing district
$
_individual's spouse.)See reverse for details.
Have you filed for any other deductio ? If Yes,who d u ctions?
Pl./es ❑No `�� \v�
Have you filed for deductions in any other county'? If Yes,what county?
❑Yes rnil! go
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
1,0,riGe of applicant , Date(month,day,year)a
a.cos
ges'of appliNt (number and street,city,s ale,and ZIP code) ^
Signature of authorized re-presentative �lT)—��'_`. Date(month,day,year)
e of authorized representative (number and street,city,state,and ZIP code)
Sign eo ou�nty Auditor /'a ' ^ � 1` \/ ��\��`r�-�/ , Date(mo�nth�d-a year/
�.[� 9� Q 0 t\-\� W V,I�L. !_`t__ tom, �) Y�1�\C�1 J �- iy_�,'�)
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FILED
MAY 1 2 2022 •
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR