Age_Wethington mot,.. ,,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
Ri �� State Form 43708(R15/1-20) _ � Q
I= -, Prescribed by the Department of Local Government Financec. c C€��T .
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 all that apply)ISIX:‹7; ,,��,,�
65 Deduction from Assessed Valuation Lj Uver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is his/her exec are or interest? If owned with joint tenant or tenant in common,indicate with whom.
It'<;.-. ❑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?
I S s ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
M ‘ l ^ at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
[ c al property ❑Mobile home(IC 6-1-1-7)
Taxi g district Key number/Legal description. O - W Record number Page number
.. 4
Does applicant reside on property? Assessed value of the
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Y.es,,what deductions?
'' es ❑No S1 IrY\O", -
Have you filed for deductions in any other county? If Yes,what county?
❑Yes li-tlo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si ature of applicant_ , n Date)(month,day,year) ? Z'
�h bllv�.l+ev C/y — 2,2
Address of applicant (number and street,city,state,and ZIP de)
Signature of authorized representative 1 Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signa ure of County Auditor ^ ^ 5 Da�(month,day year)
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FILED
JUN 2 2 2022
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer