Age_Watson ,/,-----i:-----..\\,,,,.. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
-4'.7. 1-:: PROPERTY TAX BENEFITS
,1: State Form 43708(R15/1-20)
1 Prescribed by the Department of Local Government Finance C:::31 Seprl.
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.
Type of benefit requested(Please check all that apply)
1:9<er 65 Deduction from Assessed Valuation [ .43cer
Name pplicant(owner or co)itract buyer)
.--E-,
I applicant t ole le r equitable miner? If No,what is his/her exact share or interest? If owned with jloint tenant or tenant in common,indicate with whom.
1es ON°
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?
Res ENo
Name of contract seller I Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
Fii,lr‹. El No
Address of contract seller(number and street,city,state,and ZIP code) Is the p,!..-gperty in question: _
IFIL<eal property [I]Mobile home (IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Pet r\C_C.---AC . Ol.Z" ID-0-1 - `-k0.3- 00 1, - L4 t" 0.D9 .
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
(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and 5199,999(all Indiana real
Prg 0 No property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31_2f the year
TOTAL $
individual's spouse.)See reverse for details.
Have you filed for any other deductioj:A? If Yes,what deductions?
No t-k 4- rIn Q&A-isdr(1,-(ZrC ,
Have you filed for deductions in any other county? If Yes,what county?
El Yes 1..hrc(
I/We certify under penalty of perjury that the above and egoing information is true and rrect.
/—\
Date(month,day,year)
Signature of applir>nt 444/ —
V
Address of applicant (number and street,city,statg,and ZIP code)
- Pr't r\c_c_A-cr JO • 1-4.--2N1-1 0 •
Signature of authorized representative Date(month,day year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day year)
-ft,•(-\.ca.a_Ju, a . ,k_ 3cLAii._L,; .,Dify, .
MAY 0 9 2023
')-2,.dieue & Pir-. )
GIBSON COUNTY AUDITOR