Age_Gladish APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
It PROPERTY TAX BENEFITS
•
State Form 43708(R15/1-20) Gibson Princeton 2022
'b B, Prescribed by the Department of Local Government Finance
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)
®Over 65 Deduction from Assessed Valuation I I Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Roger& Donella Gladish
Is applicant the sole legal or equitable 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
Do all joint tenants or tenants in common reside on the property?
If name on record is different than that of applicant,indicate below. m Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
I at least one(1)year before claiming deduction? ®Yes ❑No
Is the property in question:
Address of contract seller(number and street,city,state,and ZIP code) ®Real property ❑Mobile home(/C 6-1-1-7)
Taxing district
Key number/Legal description I Record number I Page number
Princeton 26-12-07-404-000.959-028
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
7� (counting just the
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
®Yes ❑No Homestead, Mortgage
Have you filed for deductions in any other county? If Yes,what county?
❑Yes 21No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Date(month,day,year)
Signature of applicant 11/29/22
Address of app nt (number and street,city,state,and ZIP code)
625 S. Stout St., Princeton I Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city,state,and ZIP code)
I Date(month,day,year)
Signature of County AuditorL6A u _. - _ O.
w^ net- I rr r' 11/29/22
FILED
NOV 2 9 2022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-
Taxpayer GIBSON COUNTY AUDITOR