Age_Harper Fn,*Ec APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
,.1 PROPERTY TAX BENEFITS
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RI; , L�� State Form 43708(R15/1-20), : '. �20
;,18/ Prescribed by the Department of Local Government Finance Ason. akitek
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 the k all that apply.)
Oyer 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
-Dori nod_ Ke.(I No, /
Is applicant the sole legal or equitable//// owner? If o,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
FYes ❑No
If name on record is differe t than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
❑Yes El 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) itthf property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district / ! /� Key number/Legal description Record number Page number
c tnf L� 4-/ 71. -J e-)09 -me) . 602.-. b0%
\ / Does applicant reside on grope v 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
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individual's spouse.)See reverse for details.
Have you filed for any other deductions If Yes,what dgductions? zaoc
es ❑No /�-f/r(�J
. Have you filed for deductions in any other cou y? If Yes,what county?
�/(�- ❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Signatu a applicant Date(month,day,year)
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Address of pplicant (num and tr a city, te,and Z dne) �/�and
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
3uofountyAj {uditorDate(mon ,�lay,year)
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• OCT 1 6 2020
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
GIBSON COUNTY A TOR