Age_Barrix ,t � APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
X% PROPERTY TAX BENEFITS
7tf\, 1: State Form 43708(R15/1-20) •
��• Prescribed by the Department of Local Government Finance �soy., ��LC�OI't
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. ���
Breaker Credit
Name of applicant(owner/or`contract buyer)
C,\Q.C\ �• \x
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
0'�es ❑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?
Dyes ❑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 the property in question:
❑Real property ❑Mobile home(/C 6-1-1-7)
Taxing district ^ Key number/Legal description Record number Page number
Vt.-I - 07- 3oio--toa. 7.77 -oas
Does applicant reside on pronely? Assessed value of
Yes ❑No 1—low•C eca
Have you filed for deductions in any other county? If Yes,what county?
Dyes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signaturnof applicant- Date(month,day,year)
�
0/2 LJ A�JJ 7- 404-3
Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of ounty Auditor Date(month,day,year)
/ 7 /a-3
FILED
FEB 0 7 2023
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
