Age_Caringer eq APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP ' YEAR
°7 14; PROPERTY TAX BENEFITS
•, . State Form 43708(R15/1-20) \ �� ^
;,�s 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.
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Re of applicant(o r or contract yet) 1 6 90 5 5-C.4)
�lc�l‘a }noes I
0 _. �Is a r gal or equitable caner? If o,what is his/here *- a or interest? If owned with joint tenant or tenant in common,indicate with whom.
III Yes ❑No ,
If name on record is different than that of applicant,i ' to• low.: . Do all joint tenants or tenants in common reside on th petty?
l es ❑No
Name of contract seller ^ Has applicant owned or been buying the property under recorded ntract for
Wyyk" �O at least one(1)year before claiming deduction? ❑No
Address of contract seller(number and street,city,state,an ode) Is the p erty in question:
e�/�rrg Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Le,al tij �` Record number Page number
C� �� • 2 .,- per' i o ( -4300 . MI 6 -02�—
Does applicant reside on p p ? Ass ,'-.' .fue of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Yes ❑No [couhing 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 December31,2019.)See reverse for details.
Is the applicant 65 years f age r more on December the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deduct If Yes,what deductions?\
Yes ❑No \) C '
Have you filed for deductions in any other co ? If Yes,what county?
❑Yes �O
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signaj�e f applican 1 Date(mo th, �ayn,le r)
Address of applicant (n bet and street,city, te, d ZIP code)
25-11 (� 511 / 1r 11.�r LYr 4�c� .
Signature of authorized representative it Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of(f](r(tyk)iitOr J ---DDate(mont day, ear)_ Z
FILED
��11-1.-- 10( -000 • 1ct6.. Oz MAR 4 2021
rGIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpaye