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Age_Auberry E�64, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR •` a PROPERTY TAX BENEFITS . : State Form 43708(R15/1-20) h �± ti :.:z_." 0� �0�1 U °`",—e `� 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 ver 6 e uction Assessed Valuation ❑ ver 65 Circuit Breaker Credit Name of applicant(owner or contr buyer N l' Is applicant the sole legal or quitable owner? [lfNo,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. Yes ❑No If name on record is diff en than that of applicant,indicate below. Do all joint tenants or tenants in common reside e property? es ❑No Name of contract seller Has applicant owned or been buying the property under re r 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) I t property in question: Real property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number n 2,q-- . 2--12-24—Lion-Ool -q--3 O —0 2 + - Does applicant reside on• •pe •? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 es ❑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 65 Circuit Breaker Credit ini'ally applied for after December 31,2019.)See reverse for details. Is the applicant 65 years•-ag or more on Dece be 1 of the year $ individual's spouse.)See reverse for details. Have you filed for any other ded cf s? If Yes,what ded ctions Yes ❑No �\J MoLi C • Have you filed for deductions a other ty? If Yes,what county? El Yes No I/We certify under penalty of perjury th t the above and foregoing information is true and correct. gnat re f applicant Date(month,day,year) c I 3-8-2 / Address of applicant (number and street,city,state,and ZIP c e3E ) 22.-CE .. S-t) ,_C f'-for,- JY)- �a--6 - Signature of authorized representativ.� Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signature oLO 01. r FILED Date�Qnt r)r `"' ` 11 2) MAR 8 2021 , GIBSON COUNTY AUD ITOdd DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer