Age_Stevens <0,---•-.q, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
s PROPERTY TAX BENEFITS
State Form 43708(R15/1-20) G(6 so, VbS�dt cQ�
iO1i-: , 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) �
`Ire i n ' -eJ et"
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or esL 111/ •with j int tenant or tenant in common,indicate with whom.
L.Sres ❑No
If name on record is different than that of applicant,indicate below. Do all joint nts or tenants in common reside on the property?
22 ft]�es ❑No
Name of contract seller DC 7Has applicantpl owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction? [Lii‘s ❑No
Address of contract seller(number and street,city,state,and ZIP code) Z,4/ 2 4; o is the pr,perty in question:
GIBSON COUNTY AUDITOP, IFIM<eal property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
14.0"b51-p,A.1- a6-a3-o(o-ao( -oo0. SS0- oocr
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
[counting just the
_
Have you filed for deductions in any other county? If Yes,what county?
❑Yes [I't
1/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sign of applicant Date(month,day,year)
s/; —e:;'.7 ---
Ad o applicant (number an ilaiii,city,sta e,and ZIP code)
5 3 5 9 tk A4."¢ fI0.Vb5}1,.c(+ 7 / 9'76 39
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County A ditor Date(month,day,year)
/ 1-P"' 4j
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer