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Age_Hulfachor .o04q, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR m ) PROPERTY TAX BENEFITS a State Form 43708(R15/1-20) �O n If 1 2$ r O 2 I b ' =- Prescribed by the Department of Local Government Finance \ V 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. Type of benefit requested(Please check all thaLapoly.) Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit Name of appli ant(owner or contract buyer) a.r2P_..s� L. f h ? ' Is applicant the sole legal or equitabl wner? 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 the r party? 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? „....j:;1-ye-s--D No Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: eal property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number 12.fi0c.4.-.= x 263'-/2- oafs- 7. >3 ocY • �,3 - ©vZef Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 ❑Yes ❑No Bunting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999 fall 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) f the year $ individual's spouse.)See reverse for details. Have you filed for any other deductions? If Yes,what deductions? es El No Ff(%�iCL- Have you filed for deductions in any other county? If Yes,what county? ❑Yes L-1.,6,.Pao" r.'— I/We certify under penalty of perjury that the above and foregoing information is true and correct. /Si nature of applicant Date Date(month,day,year) Ad ss o applicant (number and t et,city,state,and ZIP code) `(' � �-1I (`^ "`� D 5 q_jci-z/7<.5 ''?cam /�d"r .'7a.. /r - tT-_:>-1. ( W �7�7 C._.�/ Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Sign• ure of County Auditor Date(month,day,year) f .4./7 I ►'2 3 -at7 Z/ FILED y� NOV 2.; 2021 DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer it/LiMaze a% �. n4.) GIBSON COUNTY AUDITOR