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^ q, APPLICAl'ION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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7;�..'t�- �: PROPERTY TAX BENEFITS
a\ "t I' State Form 43708(R15/1-20)
''' -raii.�� 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 check all that apply)
®Over 65 Deduction from Assessed Valuation VI Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Juanita Meadows
Is applicant the sole legal or equitable 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
___ _ ILname on.record is different than that.of.applicant._indicate-below. _ __ __— - .___—__ _ _ Do all joint tenants ortenants-in-common reside-on the property?
❑Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
N/A at least one(1)year before claiming deduction? IZIYes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
®Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Owensville 26-17-01-404-000.533-022
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
IZYes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
❑Yes IZINo
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature o:applicant :-D (rror!h do,:'''''or)- '
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Address of plicant (number and street,city,state,and ZIP code)
306 N nd St, Owensville, IN 47665
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signs r of County AuditorjAr..*....i.e.13......,
Date(month,day,year)
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FILE '
SEP 0 4-2020
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBBON COUNTY AUDITOR