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s,., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
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� :� .:;��f State Form 43708(R15/1-20) ,��� +�0
`8 s�r 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 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. f h --
Type of benefit requested(Please c ck all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or con ract
XIf owned with joint tenant or tenant in common,indicate with whom.
Yes ❑No
If name on record is differ nt th n that of applicant,indicate below. Do all joint tenants or tenants in common resid the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under reco ed contract for
at least one(1)year before claiming deduction? ❑Yes ❑No
Address of-_- -: :
f 1.1 .r, - eal property ❑Mobile home(/C 6-1-1-7)
Taxi , •istrict
exceed$200,000 for Over 65 Deduction or$199,999
(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999 tall Indiana real
Yes ❑No
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 December 1 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other dedu ions? If YesAhatde uctions? 1 s,0 e
Yes ❑No J dL t'ItiAl
Have you filed for deductions in any other`�' 'ty? If Yes,what county?
❑Yes l4Wo
I/We certify under penalty of perjury``that the above and foregoing information is true and correct.
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Address of applicant (num r and sir et city state,and ZIP cod ) ll/
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signat r of Co nt Audijor 4• ildi / Date(mot d ear)
ALL0
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FILED
JAN 0 6 2021
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
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GIBSON COUNTY AUDITOR