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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
°rPROPERTY TAX BENEFITS
7rSlS` State Form 43708(R15/1-20) //�� ,--}�
`s, ' Prescribed by the Department of Local Government Finance L 2)�50rj O; 1.1
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
❑Over 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
Name of applicant(owner or contract bu r)
1,_.0.-0`a 1 n kosr#
Is applicant the sole legal or uitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Yes ❑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?
[3--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? [ y6-S ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the pro erty in question:
eal property ❑Mobile home(/C 6-1-1-7)
Taxing district
nnnn --
t❑�es ❑No Je \ ` �S t M4,4-
Have you filed for deductions in any other county? If Yes,what county?
❑Yes ❑Ipt6
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of a pl n4 Date(month,day,year)
/�-}:wj /O — %41—c Address of applicant (number an street,city,state,and ZIP code)
-70 GI ' J 800 S For.{- c-c v c�--. —Li/ u 76Lf S
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor �. /— Date(month,day fO qr) /
FILED
y OCTI 1 4 2022 �V
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer `'l arc a t. iced)
GIBSON COUNTY AUDITOR