HomeMy WebLinkAboutAge_Jones s-,!. , APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
(. -' PROPERTY TAX BENEFITS
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IA� , State Form 43708(R15/1-20) \��,^ 012
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\Fat < 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: Form must be completed and signed by December 31 and filed with the county
Type of benefit requested(Please the k all that apply) "� '
Over 65 Deduction fro d Valuation I�Over 65 Circuit Breaker Credit
Na of a licant_`(owner or c tract uyer) v�� �C ^\
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Is apple r equitable owner? f No, exact a or interest? 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 the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under re d d contract for
at least one(1)year before claiming deduction? s ❑No
Address of contract seller(number and street,city,state,and ZIP code) I tl- property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
0 IS —O 7-al 7— al OD -i ol-OOO .3-I9.. 00
Does applicant reside on op 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$199,999[all Indiana real
//////�� property]for the Over
$
individual's spouse.)See reverse for details.
Have you filed for any other deductio ? If Yes,what deductions?
es ElNo \I -3
Have you filed for deductions in any othe co ty? If Yes,what county?
III Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicantX.
X/Are:49 i-g14-1— lic/511 Date(month,(Jay,y ar)
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Address of applicant number and str et,city,scatg,In :,:1'code)
1 li 6-nro jZd I �-J'n —L1 6�I O.
Signature of authorized representative " Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Ca:Th3q-
Date(month,day,year)
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FILED
NOV 102020 r ,
DISTRIBUTION: Original-County Auditor; File-StampedCopy-Taxpayer GIBSON COUNTY AUDITOR