Age_Bryant (2) o. :- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
_ y:. PROPERTY TAX BENEFITS
a ` "t = 1 17 1 Ab 1 .
'e. State Form 43708(R13/4-15)
ere Prescribed by the Department of Local Government Finance w
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Filing Dates: 1) Real Property:Form must be completed and signed.by December31 and filed or postmarked by the following Januarys.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not asses as real property:During the twelve(12)months ,
before March 31 of the year the deduction is to be effective. 8iZ��O r_-�'��
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See reverse side for additional instructions and qualifications. aki\ b,
• Type of benefit requested(please check all that apply)
•
[(Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
If name on record is differ nt t n that of applicant,indicate belo �� I.,
Do all joint tenants or tenants in common reside on the property?
'A-Yes ❑ No
Name of contract seller DEC 2 6 2019 Has applicant owned or been b in.t - .roperty under recorded
contract for at least one(1)year bef• c aiming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code)42A4coa------
Is the property in question:
GIBBON COUNTY AUDITOR Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number/Legal description . Re rd number Page number
•
) ," 7 6, 712-07 -Zoe► •-000 9-S—02.g,
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 See reverse for details.
Is the applicant 65 years of age or more on Dece ber of the year
Have you filed for any other deductions? If Yes,what deductions?
Yes No .1-1i `3}G.0 / iJc
•
Have you filed for deductions in any other county El
Yes,what county?
❑ Yes No •
I]We certify under penalty of perjury that the above an foregoing information is true and correct. r,
representative Address of authorized representative (number and street,city,state,and ZIP code)���
Ire) r. _