Age_Brown 0^7�, APPLICATION FOR SENIOR CITIZEN COUNTY
UNTY TOWNSHIP YEAR
� PROPERTY TAX BENEFITS
n
NC
2ii- State Form 43708(R13/4-15) 9J►l� DU 1�ivti .0
�"ieie/`e, Prescribed by the Department of Local Government Finance v 11
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 signedby December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured
❑ Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of a licant(owner or contract buyer)
. 0 r I CA V -)1 \j)'n .
Is applicant a sole legal or equitable own If No,wh is is/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,indif�"r Do all joint tenants or tenants in coin on reside on the property?
11 Yes ❑ No
Name of contract seller Has applicant owned or been buyi g th property under recorded
MAR 11 2020 contract for at least one(1)year bef r aiming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and Zli'code) Is the pr a in question:
eat property El Mobile home(IC 6-1-1-7)
GIB$ON COUNTY AUDITOR
Taxing district Key number/Legal descri tion Re rd number Page number
10t,) Zl • ._26 b L\ -1 2^'3°O . )06,07E
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$982,430 for Over 65 Deduction or$159,999(counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit)
❑ YesSee
Have you filed for any other deductions? If Yes,what deductions
Yes El No J I- ��
Have you filed for deductions in any other coup y? If Yes,what county?
❑ Yes o ,
•
I/We certify under penalty of perjury that the above and egoing information is true and correct.
Signature of applicant Address of applicant (number and street,cit3i state,and ZIP ode)
cAut�
XIthoerepres
antative Address of authorized representative (number and V.
city,state,and ZIP code)