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"' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
> ', a. PROPERTY TAX BENEFITS
"�� ,' ./ State Form 43708(R15/1-20) (/���C,��„f1 Qq tG�l�l2-o•
sale a Prescribed by the Department of Local Government Finance JV 1 QJ, j�.J(i
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 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 h all that apply.)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or con act yer) Ca 1n ■
liksS -
Is applicant the sole legal r uitable owner? If No,what is hUier exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Yes III No
If name on record is diff nt n that of applicant,indicate below. Do all joint tenants or tenants in common resid o the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under o ed contract for
at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is th property in question:
Real property ❑Mobile home(/C 6-1-1-7)
Taxing district 02,G . Ke mbe / gal description Record number Page number
Does applicant reside on pope ? 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
��f es CI No
prop rty]fortheOver65CircuitBreakerCr:ditinitiallyappliedforafterDecember31,2019.)Seereversefordetails.
Is the applicant 65 years•:a•-or more on Dece a 3''1 of the year
Have you filed for any other de uc' ns? If Yes,what deductr \
tyi
Yes ❑No 1JJ � C
Have you filed for deduction in a other co ? If Yes,what county?
❑Yes ❑ i
KI/We certify under penalty of perjury that t e above and foregoing information is true and correct.
Signature of app_li�nt Date(month,day, ear)
C /�2)f/J/l�/ i . ci /lam/ �A
A ss of applicarte numb and street,city,state,and ZIP code)
` ter o n S� F-1 31174\CJI‘— on - .019--b LA s
Signature of authorized representative / Date(month,day,year)
Address of authorized rep =ti umber and street,city,state,and .•-
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Signature of County Audi•• '1 ( 1 � D�a o i�;; e2.... 2 `7,0
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
cl'"�� APPLICATION FOR SENIOR CITIZEN . COUNTY I TOWNSHIP YEAR
i'
PROPERTY TAX BENEFITS
•�u�. ..!' State Form 43708(R13/4-15)
: Prescribed by the Department of Local Government Finance yy T tin
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. C g
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located.
gq/^.yy�Q.-qq/. QQ
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked bV AX felowir JAnuary 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
t/
before March 31 of the year the deduction is to be effective. _1 _- ' s
See reverse side for additional instructions and qualifications. G I B S O N COUNTY AUDITOR
Type of benefit requested((please check all that apply)
�(j Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) eali(-/6%
Is applicant the sole legal or e owne . j If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
❑ Yes ❑ No
It name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract Iler Has applicant owned or been buying the property under recorded
/n� contract for at least one(1)year before claiming deduction?
M L,—CL,— ❑ Yes 0 N
Address of contra seller(number and street,city,state,and ZIP code) Is the property in question:
D!I Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description /'Record number Page number
c fay(. CL a10-14-18 -3oa--cZ. /110 oar
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
S182,430 for Over 65 Deduction or 5159,999[counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit.)
ISkYes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ly.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)
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Si nature of authonz representative Address of authorized representative (number and street,city,state,and ZIP code)
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