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Age_Mayer �E"7f. APPLICATION FOR SENIOR CITIZEN ��= COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS ` E1= � pl T , , 01 Zo 21J � t�� State Form 43708(R15/1-20) Q ''S"-e%'4•�" Prescribed by the Department of Local Government Finance J c 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. ver 65 D ction from Assess Valuation Over 65 Circuit Breaker Credit Name of applicant(owner or contuyer) Sohn C S (AV On IA- e,k . Is applicant the sole legal or itable owner. exact share or interest? owned with joint tenant or tenant in common,indicate with whom. Yes ❑No If name on record is differ t th n that of applicant,indicate below. Do all joint tenants or tenants in common reside o the property? Yes ❑No Name of contract seller Has applicant owned or been buying the property under r c 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_the property in question: �LrA`Real property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number ©Z S 26 -I g--26-too -000. 612-o2•r Does applicant reside on prop rty? 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 S199,999(all Indiana real property]for the Over 65 Circuit Breaker Credi initially applied for after December 31,2019.)See reverse for details. Is the applicant 65 years ag or more on December 31 of the year _' individual's spouse.)See reverse for details. Have you filed for any other d / xtions? If Yes,what deductions? 1S �(� Yes ❑No l Have you filed for deductions y other o nty? If Yes,what county? ❑Yes No I/We certify under penalty of perjury that\\\\\\ the abov and foregoing information is true and correct. "if Signature of applicant �,,, /� Date(month,day,year) Addre of applicant (number and stre city, a and ZIP code) aolq S ISO W Ft- ate- Of) -y9-M Signature of authorized representative j Date(month,day,Aar ( n Address of authorized representative (number and street,city,state,and ZIP code) v^ .2k `` 1/ Signature of County Auditor 0- ) -\ Date(month,day,year) V/1JJ\ FILED OCT 212020 004:coatt----- GIBSON COUNTY AUDITOR DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer