HomeMy WebLinkAboutAge_Fisher 'A\--- ) / \2
SatiL
. \2 l 2r
`` APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
}'`, ' 14
PROPERTY TAX BENEFITS
7.Nraiitr.. f. (-)
State Form 43708 (R19 i 7-25) ( 1-Le0A1
0
2g ‘9\6--
'111•. Prescnbed 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. signed, and filed with the county auditor or postmarked by January 15 oft a! d yea
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. DEC 1 Q }
25
Type of Benefit Requested (Please check all that apply) ;
Over 65
GIBSON COU a. yrUDIT fl
`�,p ',,'� J N�AUDITOn
Is Applicant he Sol Legal or Equitable Owner?Yes ❑No If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Yes El No
Name of Contract Seller Has Applicant Owned or Bought the Prope y Under Recorded Contract
for at Least One(1)Year before Claim ng Credit?
21.Yes ❑ No
Address of Contract Seller (number and street, city, stale, and ZIP code) Is the Property in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
T g District J Key Number 1 Legal Description Record Number Page Number
ifkicg--77-)1
OA3 g(1, --(/az-o 6-Litz) _ 0O4, 6) Is , 6
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due & Payable? 0Yes ❑ No
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of licant Date (month, day, year)
2--t
� ' ‘ � �4te and !P ••• - •
Address of A t umber and street, city s )
/ /70 .5 '.7clit:-V 1,k_ a4c)e_ 1 itt/kLe_e/ti-riu, ci-74_ 1--t'U-/D
1 t
Signature of Authorized Representative Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signatu Cou Auditor Date (month, ay, year( ,..--.
oit;itte
\‘..,/, VAX) ) 013 ( ( gi (PqP. Z S
f /„.5)
DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer