Age_Young (2) ,�.v-T4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
iii �= PROPERTY TAX BENEFITS
al,..1.p
rYc ' StatesForm
ed 708the epa t 1-20) , i65� �D
\;e'" Prescribed by the Department of Local Government Finance Eir& [ //
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 K.,k all that apply.)
ver 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
Name of appli ant(owner or co tract u er)
common,indicate with whom.
Yes ❑No
If name on record is differ nt 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 recorde ntract for
at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) IV/property in question:
eal property ❑Mobile home(IC 6-1-1-7)
Taxing di 6 Key number/Legal description f Record number Page number
nee -- . 24 -/z4-zo/ -a3. 370- �.g
Does applicant reside on rop ? 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 age or more on Dece ber 1 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductio If Yes,what deductions? �2
es ❑No
Have you filed for deductions in any other oo ty? If Yes,what county?
III Yes IXINo
INVe ce ify under penalty of perjury that the above and foregoing information is true and correct.
igna r of applicant ll Date(month,day year)
/__
Address of applicant (number a street ity,state,an ZI
//// Li L9 .Uu �n �� Lf76 7 D
Signature of authorized representative J Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signs- e of.•untyAuditor fi Date(month,da,year)
/AA') Alt-• C /D/t..v/Zoo 2C:j
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F 1 L' � J
- .
OCT 16 2020
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
41
GIBSON COUNTY Al f'!TOR