Age_Berry (9) 40"'? APPLICATION FOR SENIOR CITIZEN
At ' Qt COUNTY TOWNSHIP YEAR
1 _` PROPERTY TAX BENEFITS
�lilt} State Form 43708(R16/1-23) CA\'-\- .^
Prescribed by the Department of Local Government Finance
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 he all that apply)
Over
Tenants in Common Reside on the Property?
El Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? E Yes ❑ No
Address of Contract Seller(number and street,city.state,and ZIP code) Is a Pr perty in Question:
eal Property E Mobile Home(IC 6-1.1-7)
Taxing District„V Key Number/Legal Description Record Number Page Number
0 /..-° • 26-\2-01-20q-CO ‘61 -02-S
Does Applican Re ' e on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
_ $199,999[counting just the
ElNo tfl .Have You Filed for D in Any Other County? If es,What County?
0 Yes o
I/We certify under penalty of perjury t t th above and foregoing information is true and correct.
Signature of Applicant Date(mon h,day,ydar)
��-`VY, ;�I�� 1 0� yVe? J
•
Address of Applicant(number and stye ,lity.state.and ZIP code)
alb f1e tlApi\
Signature of Authorized Representiive Fit Dte(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
NOV 0 9 2023
Signature of unty uditor Date(month,day,year)
cat a
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer