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Age_Marshall r.>- a, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR d%- PROPERTY TAX BENEFITS -� �� State Form 43708(R15/1-20) /�'� f sr-, '1v1 ,_ Prescribed by the Department of Local Government Finance File Mark1.1110 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 Type �� LY, Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of appl' ant(owner or contr.`i�buyer) r/y\ Is applicant the legs quitable ow,er? If No, 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? ❑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 th property in question: Real property CI home(/C 6-1-1-7) r Taxing district Key number/Legal description Record number Page number (fi - —0y-2y-3r —r0 °00 CIS— O7- Does applicant reside on property? Assessed value of the es ❑No Sc. \Cr---��� ` Have you filed for deductions i n they county? If Yes, at county? ❑Yes ❑No I/We certify under penalty of perjury that the above and foregoing information is true and correct. �ture of applicalnt_ 'y/�� Date(month,day,year) A ress o plica r'numbed �city,state,an IP code) \ Signature of authorized representative Date(month,day,year) Address of authorized representative (number and str ' ,,,state,and ZIP code) Signatur�e/,gf¢Q my A i r c 1T q//l� Data ,d pl:),-2r.,c ev. il. L DEC 1 5 2022 GIBSON COUNTY AUDITOR DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer