Age_Warren (3) •a, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
- % PROPERTY TAX BENEFITS
to. State Form 43708(R14/10-17) Gibson
' Prescribed by the Department of Local Government Finance
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 6-1.1-7 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)
t•❑Over 65 Deduction from Assessed Valuation 0 Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Ida Warren
Is applicant the sole 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.
ID Yes UJNo
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
likes Ohio
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming 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-I-1-7)
Taxing district Key number/Legal description Record number Page number
Princeton 26-12-07-203-003.179-028
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed 6182,430 for Over 65 Deduction or$159.999
(counting just the homestead site)for the Over 65 Circuit Breaker Credit.)
El yes El No
See reverse for details.
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?
Q Yes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
❑yes UNo
INJe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Date(month,day,year)
f 08/26/19
Address of applicant (number and street,city,state,and ZIP code)
213 E State St., Princeton
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
�t —Lek r4J 08/26/19
FILED
AUG 2
UG2 6 26/ 001199
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR