Age_Geuss 1,."- , APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�i' '= PROPERTY TAX BENEFITS
t' . State Form 43708(R15/1-20)
aohs S PI 214Cjka 2b2b
a 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: Forth must be completed and signed by December Si and filed with the county auditor or postmarked by the following
January 5 of the calendar year in which'the property taxes ale first due and payable.
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check al at apply.)
Over 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
Name of applicant(owner or contr ct buy
Aenr)°cam- • j Btj 55
If owned with joint tenant or tenant in common,indicate with whom.
Yes ❑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 ill No
Name of contract seller 'Has applicant owned or been buying the property under recorded 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 the in question: '
Real property ❑Mobile home(IC 6-1-1-7)
Tax di rict Key number/Legal description Record number Page number
a aka j 't44 -05. 3 3 •2.oD->�03-751-paw
Does applicant reside on prope 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 bn December 31 he year
$
individual's spouse.)See reverse for de r s.
Have you fled for any other deduoti s? If Yes,what deductions? L
es ❑No aL/d ?M cilj�a D
Have you filed for'deductions in any other coun If Yes,what county? e
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct. '
ipdalu of applicant Date nth,da ear) D D
s....--
of (---'
applicant (number an street,city,state,andZlPp6�'e)2 /�1( 471-70
Signature of authorized representative //CJ(xl•] Y/✓ nit'G/ Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign re f County Audit • Date(month,day yea)
ue
10/9�PD
FILED
•
OCT 0 9 2020
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer 42/14:C.'cad .
GIBSON COUNTY A TOR