Age_Douglas _R-r,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e/ : PROPERTY TAX BENEFITS tI11
yl 1 State Form 43708(R15/1-20) \i.`t C^^
'+ 'trip„'' Prescribed by the Department of Local Government Finance ��..JJ `mod^
File Mark
L'hformation 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
Name of applicant(owner or contract buyer)
Is applicant the sole legal o�rr equitable-,/'� owner? If No, hat is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Lt,�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?
2'irjs ❑No
Name of contract seller Has applicant owned or been buying the property under re�co-,r,d�e contract for
at least one(1)year before claiming deduction? Vd7eS ❑No
Address of contract seller(number and street,
.
Have you filed for deductions in any other cooup/tv� If Yes,what county?
❑Yes L_ o
I/We certifyytnder penalty of perjury tha he above and foregoing information is true and correct.
Signature of pli fpant O Da (month,day,ye r)
Address o a cant (number s ett,,-city state,and IP c de) �� \ r \ t \,tom` �---1 \1 �'
Signatureauthorizedrepresentative FJ / .) Date(month,dayay year)l "fir
Address of authorized representative (number and street,city,state,and ZIP code)
Sig nature of County Auditor . ) �_A ""/ V/Y� 1�-S- Q-09 c3 •
FILED
DEC 5 2022 /V�
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR