Age_Greene dam"f APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR
b.-- PROPERTY TAX BENEFITS ��yy
. State Form 43708(R13/4-15) •, o Q�1 K �7K\ 19
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\%e' Prescribed by the Department of Local Government Finance 11/VV/WW�✓✓``""�� K GlJ 1
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 Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-I.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 requestteded///(please check all that apply)
Over 65 Deduction from Assessed Valuation Lj Over 65 Circuit Breaker Credit
Name of applicant(owner r contract buyer)
jtit , 1t- OYceA e .
Is applicant the sole legal or equitable own If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
/ indicate with whom
Lam,Yes [1] No
If name on record is different that of applicant,indipelert Do all joint tenants or tenants in common reside on the property?
gill Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
FEB14 2019 contract for at least one(1)year bgfore claiming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and code) Is the property in question:
GIBBON COUNTY AUDITOR Real property n Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
cba.0k0/1/4_ \wsr . 7. 6-04 --36-100-0oo . b? -02:3-
Does applicant reside on property? Accessed value of the property as of current year assessment date(may not exceed
S 182,430 for Over 65 Deduction or 5159,999(counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit.)
YesSee reverse for details.
Is the applicant 65 years of age or more on Deco be 1 of the year Applicant's date of birth(month,day year) If filed by a surviving,unmarried spouse,what
prior to the year taxes are first due and payable?
Have you filed for any other deductions? If Yes,what deductions?t "�
m
',mil Yes ❑ No k ,1 )v`+t \�/ ll C
Have you filed for deductions in any other county? \ If Yes,what county? �1 C
❑ Yes No
•
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
* D\i,-4-8 N ova us H,>s,1 -� 1 Q lipi, On_
ignature of authoriz repre tative Address of authorized representative (number and street,city, ate,and ZIP code) ( 1'�,-( 1�
I 10