Age_Slunder (2) o �. =E�, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�;1;‘%;:-.,a PROPERTY TAX BENEFITS
a; State Form 43708(R15/1-20) ki&V . -^
SaltPrescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
i;
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is locate . ILL II
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by thijlElldwro 2020
January 5 of the calendar year in which the
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check that apply.) GIBSON COUNTY AUDITOR
DITOR
Over 65 Deduction from Assessed Valuation D •ver 65 Circuit-Breaker,Credit
•
Name of applicant(owner or contract buyer)
Is applicant the sole leg or equ le owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es ,-❑No • , •
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on property?
. , - Yes ❑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 perty in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxi n di nct e7 Key number/Legal description Record number Page number
it -4.3-35-300 - 003 . ., Sj k -o 17
Does applicant reside on property? / Assessed value of the property as of.current year assessment date(May not.exceed$200,000 for Over 65 Peduction orS199,999
Yes ❑No (counting just,the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999. tall 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
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
Yes : '❑No 5` Alf C)
Have you filed for deductions in any other county? ' If Yes,what county? J . •
❑Yes, �lo _•
I/We certify under penalty of perjury(that the above and foregoing information is true and correct.
Signature of applica Date(r_nonth,day,year)
iC/1.) a
Address of applicant (number and street,city,state,and _ZIP code)
8.1 %J' IL t7SAf P 'ee1'd&.I , '79 7O
Signature of authorized representative Date(month,day year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign r of CountyAuditor 4 Date(month,day,year
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer