HomeMy WebLinkAboutAge_Grable �•*. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
( l \, . State Form 43708(R15/1-20) C,. 1y.w^yr� ^�1
�> --'.+' Prescribed by the Department of Local Government Finance (.4L�..f \ P.
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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 Il that apply.)rat i �,,�
ver 65 Deduction from Assessed Valuation I_• -t er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer
.r- r G` CLAvk f,
If owned with j
Is applicant the sole legal equitableo,r�� ��,�� oint tenant or tenant in common,indicate with whom.
owner? If No,what is his/her exact share or interest? 1
L►15 es ❑No
Do all joint tenants or tenants in common reside on t property?
If name on record is different than that of applicant,indicate below. es ❑No
Name of contract` 1 seller Has applicant owned or been buying the property under recorded contract for
Y•`---'' \P\ at least one(1)year before claiming deduction? s CINo
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑Real property El Mobile home(IC 6-1-1-7)
Key number/Legal description Record number Page number
T mg district u O
Does applicant reside on props Assessed value of the property as of current year assessment date(May not 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[all Indiana real
es No property]for the Over 65 Circuit maker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 f the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions •
Have you filed for deductions in any other county}„,r un,ty'" If Yes,what county?
El Yes , o�
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Date(month,day,year)
Signature of applicant I t _. 540 �'1 I
Address of t (n�° an street, ity,state,and IP code) e�.J�L-/C1.+�
0 j. t(?�C.-�._.I 4 -'c- .) *".' ►rN G ' -Van, ,
Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city,state,and ZIP code)
Date(month,day,year)
Signature of County Auditor\'41\c..\\k.-10 V-V.1 A_ . a . ) a_ t" 1 A ,- a..--,z
F ILED
NOV 222/ ,02< .
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer