Age_Ray (4) ,c+.jrr APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
c - qtA, PROPERTY TAX BENEFITS
x • �;i State Form 43708(R15/1-20) 1 ��
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Prescribed by the Department of Local Government Finance 3�� ` a V 23-
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
— �'
Name of applicant(owner or con act yer) (✓�^� k,t
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4 �"\s '
Is applicant the sole legal or equitable owned? If No,what is his/her exact share or interest If owned with joinilenal�t or tenant in common,indicate with w om.
❑Yes ❑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?
Y S ❑No
Name of contract seller Has applicant owned or been buying the property under rec ed 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 property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
.26-12-01-301—t-oca-260- Cat,
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
❑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
$
Have you filed for any other ded c ons? Ij ygs whet deductions?
Yes ❑No {1'I� .
Have you filed for deductions' any other o nty? If Ye ,what county?
❑Yes No
I/We certify under penalty of perjury t at the above and foregoing information is true and correct.
Sig ture of applicart Date(mon day kyea')
/et
. Az (a6,ut,. ottA, LeAer Li. 2, rA,0 2, 2--
dress of appli nt (number and str-- city,state, ZIP code)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signa re of my Auditor // Dat (m nth day, ear
1 FILED Z2
APR 2 4 2023
GIBSON COUNTY AUDITOR