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Age_Dayanan x APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR d4, \. PROPERTY TAX BENEFITS // 7N` 1 State Form 43708(R15/1-20) l C O,^ © 2 � `7 +. Prescribed by the Department of Local Government Finance v C� (� 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. Name of applicant(ow or con ac buyer) bin eri1� - )'-.J\ -'-' n►, �� Is applicant the sole legal o unable owner? If No,what is his/her exact share or i est? If owned with joint tenant or tenant in common,indicate with whom. Yes ❑No If name on record is different th 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 re rded 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���,tth.�-p�roperty in question: / \ Real property ❑Mobile home(/C 6-1-1-7) Taxing district ICD2CZ • n_Key_numberi2-O`t/Legal description — 4c — n 0\. Ct61— oZ8• Record number Page number Does applicant reside on p ? 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 homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real Yes No property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details. Is the applicant 65 years age r more on Decem e 1 of the year $ individual's spouse.)See reverse for details. Have you filed for any other d u ions? IIf s`w t dt~ductio s? Yes ❑No , l`V ll ` Have you filed for deductions)l a other ty? If Ye§,w t county? ❑Yes No I/We certify under penalty of perjury that the above and foregoing information is true and correct. XSignature oapplir S-k— 1 ` :=y() `A Date(mont day,ye ) • Address of appl' nt (number and street,city,state,land ZIP code) �,Signatu epresentative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) SignatureMnrM- Date(month, ay yea n FILED DEC 2 0 2022 a� ) GIBSON COUNTY AUDITOR DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer