Age_Wilson ��- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
}i-��dd 'I PROPERTY TAX BENEFITS
f State Form 43708(R15/1-20) c CJ O r O acI\ (/�-n ^)arm
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
'
// ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
tIarrg applicant(o ner r,c ract b er)
c�k.:\e U iVos
s applicant th I o e uitable owner? If No,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 differ nt t an that of applicant,indicate below. Do all joint tenants or tenants in common resid o the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under e 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(/C 6-1-1-7)
Taxing district Key number/Legal description
2G-1q-��, �— o °O. 13 —0 O Record number Page number
0� � -
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 [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
$
individual's spouse.)See reverse for details.
Have you filed for any other d u-ions? If Yes. at\de uctions??
Yes ❑No `j
Have you filed for deductions' any othe o
Wty? If Yes,what county?
❑Yes No
I/ e certify under penalty of perjury
that\ the above and foregoing information is true and correct.
x Signature f ap licant Date(month,Tar,ye )
VfJr/
Address of plicant (numberrgd street,city, ate,and ZIP de)
Signature f authorized representative Date(month,day,year)
Address of authorized representative(number and street,city,state,and ZIP code)
S_ignatuy f Co Auditor " / Date(monda/�ar 7/(1)Z2
dill V'l—t vvGG
FILED
MAR 1 6 202Z
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer