Age_Barrett eY�„ APPLICATION FOR SENIOR CITIZEN con • , ; TOWNSNI;m
S `: PROPERTY TAX BENEFITS
S State Form 43708(R14/10-17) _ I• !"t
Wy Prescribed by the Department of Local Government Finance
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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 l ocatteda ' I.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed orpostmari edgbyfthe following January 5tTOR
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply)
RI Over 65 Deduction from Assessed Valuation 0 Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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Is applicant the sole I orr-¢g unable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
(y)Yes 0 N
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
—_ Yes—Stio'— -
•
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before daiming deduction? g[I Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
[V Real property ['Mobile home(IC 6-1-1-7)
Tying district Key number/Legal description Record number Page number
InOn T,rrnshsp 210- 17-,0 -IOC 6-10 050 Oa a
Does ap ldant residd on property? Assessed value of the property as of current year assessment date(May not exceed$182,430 for Over 65 Deduction or$159,999
I�IYes ❑No
(counting just the homestead site)for the Over 65 Circuit Breaker Credit.)y /�l
See reverse for details. 4/
Is the applicant 65 years of age or more on December 31 of the year (
Have you filed for any other deductions? If Yes,what deductions?
RCes El No #011w5-4-Pans ct 2.0filvmmip I
Have you filed for deductions in any other cou ty? If Yes,what county?
Dyes [d No
WJe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant �.^^,A Date(month.day,year)
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Address of a V V I #9/- -
applicant (number 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)
Signatur of C my Auditor Date(month,day,year)
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A ILED
AAA MAR 5 - 2018
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer f/,^�' Ir
GIBSON COJ1'`ITY AUDITOR