HomeMy WebLinkAboutAge_Lee at5- F� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
° %il,.1 PROPERTY TAX BENEFITS
l/' State Form 43708(R15/1-20) ,� `O'0 Q p�'�"T �7
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i i%e Prescribed by the Department of Local Government Finance ,
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 ofa • nt ownerorcont ct uyer) ' \
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Is applicant the sole legal e itable 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 differ nt t n that of applicant,indicate below. - Do all joint tenants or tenants in common reside o the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under co ed contract for
at least one(1)year before claiming deduction? Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is f• property in question:
Real property ❑Mobile horn (IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
d � • 26-I Li—1 B—\O-V000, 22]—0 0O- .
Does applicant reside on. •p r,? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
es ❑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•,age•r more on Dece ber of the year
$
Have you filed for any other d du ions? If Yes,what d uctions
Yes ❑No 'f `
Have you filed for deductions' a other u ? If Yes,what county?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
X Signature of applicant Date(mont, ear
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Address of applicant (number and sire city st e,andZIP c e)
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Signature oriz d re resentativd Date(mo y,y
Ad res ofauthorize�fepre entative (number and street,city,state,and ZIP code) I
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ISignature of Co or C -1 k .I, Date(month,day,year)
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AUG 5 2020
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer