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Age_Richardson (2) ,+s""d APPLICATION FOR SENIOR CITIZEN i � COUNTY TOWNSHIP YEAR �� -, .i.l..a PROPERTY TAX BENEFITS I( r;� State Form 43708(R15/1-20) /� /� �2,a�O Prescribed by the Department of Local Government Finance (J v 4-- Z/•O V 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 properly 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. Type of benefit requested(Please check all t ply.) ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit Name of applicant(owner or ntract buyer) red o_ / a rA r.�,5 ` Is applicant the sole legal or equitabl caner? If No,what is his/her exIct share or interest? If owned with joint tenant or tenant in common,indicate with whom. es ❑No I If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the prbperty? es ❑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 pr y in question: Real property ❑Mobile home(IC 6-1-1-7) Ta ' district eaL.,_ Key number/Legal description Record number Page number a � .// 26-/y-/e:,— /02- o©e°, 9/0 -e)© 7 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 S199,999 ❑Yes ❑No [counting just the $ Have you filed for any other deduction If Yes,w at deductions? /, �/ es El No � ; �f- Pi!JI`��LL Have you filed for deductions in any other county? w at county? Ell Yes o I/We certify under penalty of perjury that the above and foregoing information is true and correct. Si al a of applicant j Date(month,day,year) (,"... / - 1)2 3 Address of applicant (number a d street,city,state,aed ZIP code) 925 �Z "'I ve- , �,2/�' ,7z to D Signature of authorized r resentative r Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signature of County Auditor Date(mont ,day,y r) ` 6GI? o-�`A / t /e/./A j , ¢�/1 zoo !LED APR 1 4 2023 &r GIBSON COUNTY AUDITOR