Age_Tremps 05; a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4' PROPERTY TAX BENEFITS \
. c(State Form 43708(R13/4-15)�me�J Prescribed by the Department of Local Government Finance 9 so() - `I� ���
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 CountyAuditor 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
• Type of benefit requested(please check ell that apply) ((��
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
•
Name of applicant(o ner or tract er)
a.CUA 6J C'‘ 1 C*\111 et) I-1(12S'
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
es ❑ No
If name on record is differe th that of applicant,indicate bel I Do all joint tenants or tenants in common reside on the property?
DEC � 02019 ❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before iming deduction?
_i 4i Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP co,-' v / °r Is the property in question:
GIBSO COUNTY AUDITOR
. Real property ❑ Mobile home(1C 644-7) •
Taxing district Key number/Legal description R Ord number Page number
\ rAe .0 \ Z) 17-a-2o2 —oo n . 131 -o ,
Does applicant reside 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[counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit.)
❑ Yes
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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