Age_Offil ,.•-TA.,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
1 PROPERTY TAX BENEFITS 1 �7
State Form 43708 epa/1-20) To
�O �7 `b ,e,� ?, 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
Name of applican w r or cot ract'uyer) < '
Is applicant the sot I a or equitabl\owner? If izihat 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 he property in question:
Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legg!description ✓ Record number Page number
26—\L\— I -303-00 f88-oo
Does applicant reside on pr rty? Assessed value of the property as or current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Yes ❑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]for the Over
TOTAL $
individual's spouse.)See reverse for details. `�
Have you filed for any other deductions? If Y s at deducti 1 l
❑Yes ❑No � ( lMV) U \\` ,D ONO cr IN,I_OLC CA 7k /1 9 e)
Have you filed for deductions in any other county? If Yes,vnat county 1-7
❑Yes ❑No C �}}�� ZZ IP 23 y� G ---�
I/We certify under penalty of perjury that the above and foregoing information is true and otYec. t'llI • - ll►1 O `^` ' r'1 .�
Signature of applicant Date Tonth,d y,year)
-11�.*. c. cam ) \ 7_� 11-pZ2
Ad ess of applicant (number and street, y,state,and ZIP co
3N �vis1o�, St- 0 Vir-0 Ci- - 'f-1- 1-0-6-6 p.
Signature of authorized representative " Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County AuSjitplr,) yt t /�_ 1 Da (monte,day,�year)
Y/V/�,/f�\ (nJ,�"At�✓l jl 1rJ\�Jd(�Clt e - l 3o/t Z
U
FILED
DEC 3 0 2022 gliA
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer Vhe.cizazzi a. y►'o` alfu
GIBSON COUNTY AUDITO