Age_Meny (2) neserrunu
- APPLICATION FOR SENIOR CITIZEN COUNTY TOw is0 YEAR
�'' '"'.0 . PROPERTY TAX BENEFITS
f_ State Form 43708(R15/1-20) �0 2,0
+*' e Prescribed by the Department of Local Government Finance
teme
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 Date: Form must be completed and signed by December 31 and
Type of benefit requested(Pleas check all that apply.)
;Over 65 Deduction from Assessed Valuation LZ(Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) p � l\f\51 . 1 �"c�s-ri �1LAi ARGA-R� UT SE n U- LG� &i -Is applicant the sole legal or equitable owner? If No,what is his/her exactarec or interest? If owned with joint tenant or/tenant in common,indicate with whom.
D No .
If name on record is diffey(es
an that o pplicant,i dicate below. - Do all joint tenants or tenants in common reside on the prop rty?
❑Yes G _No
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 X(i ,ONo
Address of contract seller(number an e,city,state,and ZIP code) Is the property in question:
' , ayReal property I❑!Mobile home(IC 6-1-1-7)
Taxin district Key number/Lega�escription /` I Record number JPaen!mber�
�. -q� � - Iq�3a1-000 : Voq- ooq _
Does applicant reside on property? ' Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Yes ❑No (counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
I tri Yes®IQtvo �
Have you filed for deductions in any other county? If Yes,what county?
I[_No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signat of applicant Date(month,day,year)
` Yl I' • #'let
---,5f 7- �6
Address of appli 4t (num er and street,city,state,and ZIP cod oti_
mai
/ 1 H 7(p 39
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign re of County Auditor Date(month,day,year)
• - t- 14K3LA-) • 5•1: 1-0/0a-0_
FILED
• . MAY 212020
,iitem.roa------
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
GIBBON COUNTY AUDITOR