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•°T° a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7-; h; PROPERTY TAX BENEFITS \
0 3)11 \ OJ) 20\
.+ State Form 43708(R13/4-15) G
.-le `� Prescribed by the Department of Local Government Finance
4
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
See reverse side for additional instructions and qualifications.
• Type of benefit requested .lease check all that apply)
V. Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
1
Name of applic- •J er Or•.ntractbuyer)
• cme_freed
Is applicant the sole legal or equi le wner? If No,what i I. er exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
ti:: Yes ❑ No
If name on record is differ- t tha hat of applicant,Indic a o� Do all joint tenants or tenants in co on reside on the property?
Yes ❑ No
Name of contract seller Hasa applicant owned or been
JAN 0 9 2020 pp buy g th ropertymgunder recorded
for at least one(1)year b o im deduction?
contra
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP de) Is the. .pe •in question:
GIBSON COUNTY AUDITOR I Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal descripfip, Re.-rd number Page number
•
Ab-1 -721-1013.210-004 .
V-N(0-A" ,
Does applicant reside on property? Asessed 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
Have you filed for any other deductions? If Yes,what deductions?
XS ❑ No k1\ c.oc
3
Have you filed for deductions in any other count f Yes,what county?
❑ Yes ❑ No •
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)
,41t,t2j24 ()100% 6so C.,, V
Signature f autho" representative Address of authorized representative (number and street,city,state,and ZIP code)