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
