HomeMy WebLinkAboutAge_Haley (2) C`;\3 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
zliPROPERTY TAX BENEFITS \ ^72
State Form 43708(R15/1-20) ��1 0 2 l GU
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
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or cons ct yer) tQ \`t/wr /j , \sh`'
Is applicant the sole legal or equitable owner? If No,what is his/her exact shareor i st? If owned with joint tenant or tenant in common,indicate with whom.
El 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?
El Yes Li 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? ❑Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is he roperty in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key nu ber! gal d scription Record number Page number
G -\` ^\(0- oo-rc)) - 3 -021 ,
Does applicant reside on pr - _ r assessment date(May not exiex i$200,000 for Over 65 Deduction or$199,999
- • - uit Breaker Credit received before January 1i 2020,and$199,999(all Indiana real
Yes ❑No [pco, ••. - ••- •• = !-•- -ly applied for after December 3l,2019.)See reverse for details.
Is
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individual's spouse.)See reverse for details.
Have you filed for any other ded ions?.._
If 1Ye w t deductions?
Yes ❑No -
Have you filed for deductions i any other nty? If Yes,w at county?
❑Yes No
I/We certify under penalty of perjury th t the above and foregoing information is true and correct.
y Signature of appli Date(month,da yeal.r.
_ �t2 2
Addr of ap ican (nu gqd et,ci ,state,a;ZIP code)
6 �s i' O \A11 on . 1 �-6 b
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city-st o, d ZIP code)
Signature of u y d" r Date(mot)da,yT 1 r 2
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FILED
APR 11�20022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer a,i , - 0
GIBSON COUNTY AUDITOR