Age_Wade 1.----,,.._,.., APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
S'',::%.44. PROPERTY TAX BENEFITS
1 State Form 43708(R15/1-20)
4 ,a 6-'r Prescribed by the Department of Local
F rt- k /5
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. MAY 2 9 •
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. MAY 2020
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the f I wing
January 5 of the calendar year in which the property taxes are first due and payable.
GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply.)
tiO Over 65 Deduction from Assessed Valuation VfOver 65 Circuit Breaker Credit
Na applicant(owner or contract buyer)
Is applicant the sole legal or uitable owner? If No,what is his/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,indicate below. Do all joint tenants or tenants in common reside on the property?
'es ❑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?
El Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the roperty in question:
the
property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
et a 6 `i5_19 - /3 - ooD . 8013,.od 6.
•
Does applicant reside on p arty? 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
properly]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 Decemb 31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,yw at deductions?
[.Yes ❑No //— ,s
Have you filed for deductions in any other county? If Yes,what county?
❑Yes 'INo
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature pplicant ,� Date(month,day,year)
'l( Address of applicant (number and street city,state,and ZIP code) rY- , /,7 - I
/el 0/ _......5" a,/ --Ly- -..5541... S' r r/- aici-Aolle--4,i-
sr f authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
r
Signatur a of County Auditor - Date(month,day,year)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer