Age_Edwards '`"''" APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
It PROPERTY TAX BENEFITSNs _
tili- d.� State Form 43708(R16 1 1-23) (AIL. CZ
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"-t S ' Prescribed by the Department of Local Government Finance e wl`�'\la)4• , ,
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
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Type of Benefit Requested(Please check all that apply)
Over 65
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
L''Ni� CI No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
ECI,fer ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? ❑ Yes E No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
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Does Applicant Reside 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 homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al
U Yes E No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December 31 of the Year Prior
$
Have You Filed for Any Other,�Deductions? If Yes,What Deductions?
L�Yes ❑No 4 I .
Have You Filed for Deduction in Any Other County?
If Yes,What County?
El yes fl1
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date month,day,year)
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Address of Applicant( u ber and street,city,state,and ZIP code)
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Signature of Authorized Representative / Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor c
Date(mon ay e )it . QJ- \��,.�.� a, t D
SEP 0 6 2023
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer i?h;c/.a.e Qi,
GIBSON COUNTY AUDITO
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