Age_Selby C..-•. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�: PROPERTY TAX BENEFITS / C
� ),f State Form 43708(R15/1-20) /_ i b 50n J � •
� : .• Prescribed by the Department of Local Government Finance l� `JcNn�~
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
Name of applicant(owner or contract buyer)
DCbDco.k S21 P
Is applicant the sole legal or equitable owner? 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?
❑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? Qcs ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the `operty in question:
AI Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Fo c'k" c3 c-c/a\-c k o?(-c8-.24-off- 000. Q&7- o a co
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
s ❑No (counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property)/or the Over
$
individual's spouse.)See reverse for details. -
Have you filed for any other deductio ? If Yes,what deductions? �t�
es ❑No f-to vtt�5#e+0.�r /Vto-r-454.9<._
Have you filed for deductions in any other county? If Yes,what county?
❑Yes O'alo
I/We certify under penalty of perjury that the abov nd foregoing information is true and correct.
Signature of applicant('Y"v"" Date(month,day,Year).
Address of appli nt (number and street,city,state,and ZIP code)
107 E MQ1(c er-r1 51' Foe 3,ow•cG, :37-.✓ 9-7 67f8
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,year)
4 &)..XL.--- -y i s c: 7 /i
FILED
DEC 2 7 2022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR