Age_Voyles APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
' ` PROPERTY TAX BENEFITS
State Form 43708(R15/1-20)
6 f 10,5r2h
, 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
Lfsvver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitable owner? 1 If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
[A-Yes ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
des ❑No
Name of contract seller Has applicant owned or been buying the property under recor d contract for
at least one(1)year before iming deduction? Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is th property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing giattict Key number/Legal description Record number Page number
c\nc.etoin cp74-Ja-01-(o3-00I.SSS-0,9 FS
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
ryes ❑No [counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
'lam T property)for the Over
Have you filed for any other deductions? If Yes,what deductions�?I ��� /
❑No HOMe 5f-ea,e
Have you filed for deductions in any other county? If Yes,what county?
❑Yes `i1 o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Date(month,day,year)
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Address ifif applicant (number and slre city,state,and ZIP code)
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Audit r .--� Date(month,day,year)
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FILED
MAR 0 1 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR