Age_Robeson _7=.4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
`,;, 1- PROPERTY TAX BENEFITS ` ///���
5'\ I' State Form 43708(R15/1-20) G ��I O O t( 1,^2`�
d Prescribed by the Department of Local Government Finance \ l I'V G�
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
Type of benefit request d Please check all that apply.) ` ,, �
0M�S �\n �! •ver 65 Deduction from Assessed Valuation Ld�Over 65 Circuit Breaker Credit
Name of pplicar�(own r or • tract b yer) ✓✓ ��
1.0;1 obe�Oln
Is applicant the sole legal-r 'E.1, - -- ? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
1VYes ❑No
If name on record is differ-nt. an 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 r ed contract for
at least one(1)year before claiming deduction?
Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is th property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing distri Key tuber/Legal description Record number Page number
�n - 2G-2-3 -06-\O3 v0o 531-
Does applicant reside on prop 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 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
�j`a9T. property]for the Over
$
Have you filed for any other deduction i o If s edutions c (� t t\
Have you filed for deductions in any other,�ou,}�y? If Y s,what cou ty? fl J►oy�-/tv/I`J
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
ig lure of ap icant Date( day,year)
Nlf�h o R `.vvtal�. �� tia 2.Z .
loddress of appli9366(number and et,city,st e,and Z P code),_ r\ L\� 0
Signature of authorized represen tie ( �'I\ Date(month,day,year)
Address of authorized representative (numb
er
and street,city,state,and ZIP code) ��
Signature of County A ditor Datci�,(i, a 4C.Ja7 Z
F I ED
AUG 9 2022
/)2 tGC &-..fit Yk
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer