Age_Morris s"E Mr, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
N PROPERTY TAX BENEFITS \
"\ State Form 43708(R15!1-20)
"'' ,�;18�r, Prescribed by the Department of tar
Local Government Finance Ut V 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
Type of benefit requested(Please check all that apply)
Over 65 Deduction from Assess alu LZ(I Over 65 Circuit Breaker Credit
Name of applicant(owneror'contractbuyer) �` �� \ r1/� 0�.�
a_Is pplicant the sole legal or equit le owner? If No,what is his/her ct share o rest? ` IIf,owned,\with joint tenant or tenant in common,indicate with whom.
es' ❑No •-
If name on record is different than 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 eco ded 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 tl a property in question: '
}i� Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
• . OZLI 26-22.-t0- 3o O-o oo ;9-36 - 02M
Does applicant reside on p••- y? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
�i�Yes ❑NO [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January?,2020,and$199,999 fall 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 yeais•f ag or more on Dece b 31 of the year
individual's spouse.)See reverse for details.
Have you filed for any other deduct' If Ye ,wflat deductions?
Yes ❑No
Have you filed for deductions in any other co ty? If Yes,what county?
['Yes No
I/We certify-under penalty of perjury that the above and foregoing information is true and correct. -
Si lure of applicant oik..0_,vt...A../ 1 Date(month,da ar)
X'
Address of app i ntr{numb�{�n�sji�et,city, ,and ZIP code w�� ^µ\ ��
1 q6 J . U 11 ICJ '�i J� I-
Signature of authorized representative / Date(month,day,year)
Address of authorized representative nu and stre///e���t,city state,and ZIP code)
Signature of County Auditor Date 1,17y a•
fik CC—OL....)
FILED
. •
SEP 0 8 2020
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
GIBSON COUNTY AUDITOR