Age_Douglas (3) APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
{ PROPERTY TAX BENEFITS 1
1• �� State Form 43708(R15/1-20) 1 C O>� /r1n`�
"' Prescribed by the Department of Local Government Finance G J V" ``
fa• J Fri: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 tSfFflowipg2022
January 5 of the calendar year in which the property taxes are first due and payable. V�
See reverse side for additional instructions and qualifications. C2 .1, -
GIggO
N COUNTY AUD'R
If name on record is different than 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 recorded 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 the property in question:
Real property ❑Mobile home(/C 6-1-1-7)
Ta i district
$
individual's spouse.)See reverse for details. -
Have you filed for any other deductions? If Yes,what deductions? 1
1 1 reios ❑No //S - S►J?79
Have you filed for deductions in any other coounnt ? If Yes,what county? 7
L7l-
❑Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
•
Signature of applicat ate(month,day,year)
�` • ' • / � J.j /i pq'- o C2- a_o Z2—
Ad• .s of applicant (number and street,cit ,k,tate,and ZIP code --P `�
Signature of authorized representative Date(month,day,year)
Address of authorized representati fi number and street,city,state,and ZIP code)
igna eef f C.ouy Audit r Date(month,day,year)
Joe, n°� oY\ )ee T ct i 2z .
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer