Age_Scott "•'., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4 `.z PROPERTY TAX BENEFITS
zlar. State Form 43the708 epaR15/1-20) Q��
''am ', Prescribed by the Department of Local Government Finance (JJt •
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
whom.
es ❑No
If 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 seller Has applicant owned or been buying the property under r 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 tom'property in question: ' (( \\
Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
02q-- • 26-\2--1S—k00-001 .-1y�-02. — .
Does applicant reside on p rty7
XAssessed 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' f ag or more on Decembe 31 of the year
es ❑No \\3 CIL
Have you filed for deductions inann other co�u}ty? If Yes,what county?
❑Yes No
1/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of plica I Date(moei, f 2,Z,
Q p-, I �1
Address ofOapplicant number and street,city state,,,3nd0IP coo) n r J.^ , r
Signature of authorized representativef Ll 10.� V` b Date(month,day,year)
Address of authorized r=•• - en�.ve (number and street city,state,and ZIP code)
Signature of County AriditT1 t...
Date(mont �ew
.
FILED
SEP 1020
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer