Age_Spindler :•••*4 , APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
'4 % PROPERTY TAX BENEFITS
It .. •2' State Form 43708(R15/1-20) /_ l�5b✓� Ft /„�..._ `>t7 aZ
.'d 1+° Prescribed by the Department of Local Government Finance V j 63(�Lt cam'
� is
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 that apply.)
Ej vver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract
Do all joint tenants or tenants in common reside on the property?
El 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? CI Yes El No
Address of contract seller(number and street,city,state,and ZIP code) Isth�the�pp operty in question:
�td''F�eal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Le al description Record number Page number
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
[ems ❑No [counting 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 31 of the year
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?,
Lutes ElNo MG r eo-r(
Have you filed for deductions in any other county?,�,ty� If Yes,what county?
Oyes I_rtf
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant � Date(month,day,year)
Q--z-" ,�� '�- s`'` -r . -0,, -- ,i 6- -off- /
Address of applicant (number and street,city, tate,and code)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of`f,l Copnty Auditor �L q Date(month,
, day,year)
/glit;/,F�Y,,,,,, GIVE_/',l/,a,-rrYf�,.-..),. -^'7 1 p� " 1 (.P -- o�
J FILED
DEC 1 6 2021 #V
i`hi.c>h..g.iC CZ-.iiii:
GIBSON'COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer