Age_Sharrett a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
\:.,, "` State Form 43708(R13/4-15)
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. i
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INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located. - l E I,t
Filing Dates: 1) Real Property Form must be completed and signed by December 31 and filed or postmarked by the following p )a'v:5[ /1
2) Mobile Homes aeeaesed under IC 6-I.1-7 or manufactured homes not assessed as real property During the tweivePA Mo 9
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. ��,'�,�,�
Type of benefit requested ease check a9 that apply) GIBBON COUNT-�`y'
AUDITOR
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of a nt(owner or contract buyer) ,\
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Is a t e legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant In common,
indicate with whom
❑ Yes ❑ No
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 ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contact for at least one(1)year before daiming deduction?
❑ yes ❑ No
Address of contract seller(number and street.city,state,and ZIP code) Is the prope in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxi strict Key number/Legal description R ecord number Page number
LI r �SJ`-/00- 000. +o?-42]
Does applicant res�on roperty? Assessed value of the pprrooppeerty as of current year assessment date(may not exceed
$182,430 for Over 65 Dedu.thnt or$159,999[counting just the homestead site)for the Over
yes ❑ No
Have you fled for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
CI Yes ❑ No •
I/We certify under penalty of perjury that the above and foregoing information is true and correct. '.
S re of applicant J > Address of applicant (number and street, le,and code)
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re authorized representative Address of authorized representative (number and sheet,dry:slate,a P code)