Age_Galanos "a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS 1
` it State Form 43708(R13/4-15) 5, On P 1 Ih.. -01�j
u:` Prescribed by the Department of Local Government Finance yJ �w 111 (�U t
r
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 a property is located.
Filing Dates: 1) Real Properly:Form must be completed and signed by December 31 and bled or postmarked by the following January 5.
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 lease check all that apply)
Over 65 Deduction from Assessed Valuation IVf Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) '7�\
LON s DS . POtV t 3 s Lit P1n- in -49-670 .
Is applicant the sole legal or able owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
KYes CI No
If name on record is different that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before 9I iming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
1\ ‘vn "�-6-12-1B- lot - 001. 6Si — 028 .
Does applicant reside on property? Assitissed value of the property as of current year assessment date(may not exceed
5182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit.)
>c/ber
esSee reverse for details.
Is the applicant 65 years of age or more on D of the year Applicant'
Adjusted gross income of applicant,applicant and spouse, or
S
S25,000;for the Over 65 Circuit Breaker Credit, income may not �
exceed$30,000 for individuals or S40,000 for married couples.). • FILED
D
See reverse for details. JAR iJ 0.00
Have you filed for any other deductions? If Yes,what deductions?
QYes ❑ No \ d APR 172019
Have you filed for deductions in any other county? \ If Yes,what county?
❑ Yes Ao GIBSON COUNTY AUDITOR
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)
y
, 3s �I. ace 1 l on-DC1-tIt61t.
f autho rz representative Address of authorized representative (number and street,city,state,and ZIP code)