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Age_Murphy 7417 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR Y",_: 1, PROPERTY TAX BENEFITS t. , :Z;> State Form 43708(R15/1-20) • 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 filed with the county auditor or postmarked by the following January 5 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. Type of benefit requested(Please chec all that apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Apts4 of a plicant(owner o co ct er) Al I plican ga ore bitable owner? If No,what is his/her exdct sha or interest? If owned with joint tenant or tenant in common,indicate with whom. Yes El No If name on record is different t n that of applicant,indicate below. Do all joint tenants or tenants in common reside the property? Yes ❑No Name of contract seller Has applicant owned or been buying the property under e contract for at least one(1)year before claiming deduction? s ❑No Address of contract seller(number and street,city,state,and ZIP code) Is tt property in question: 7" eal property ❑Mobile home(IC 6-1-1-7) Taxin dis ict Key number/Legal description 666666 `\\ Record number Page number 1To n 2C —12--0 3Q\- ©o1 . g LI C - 02S 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 [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real ❑Yes ❑No 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 $ individual's spouse.)See reverse for details. Have you filed for any other de u ons? If Yes,what deductions? [ Yes ❑No H,,- /TJ5o31►1(P-sz.nt ) Have you filed for deductions in any other nty? If Yes,what county? ❑Yes No INVe certify under penalty of perjury that the above and foregoing information is true and correct. kSignat of appli t G Date(month,day,year) ���� . dig A/4��4� �,14 44 l --/i- z4 Z o Address;f applicant (number an street,city,state, lP code) 33 11 S H 1 ?VW)teN11 Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signat County udi Date(month,day,year) cr_slc 7 1k, 141 nrutA,AL. ti I i 4 "I.? r J U N 16 2020 DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AU TOR