Age_Faraone �•>*,*:; APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e� S'" PROPERTY TAX BENEFITS ///���1 ���yyy
'its)" State Form 43708(R15/1-20) ��� CS)
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�� v' Prescribed by the Department of Local Government Finance \ c-
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)
Ip
l Over 65 Deduction from Assessed Valuation 'MOver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Bernard E/Laurette K Faraone
Is applicant the sole legal or quitable 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 different than that of applicant,indicate below. — Do all joint tenants or tenants in common reside pn the property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under re riled contract for
at least one(1)year before claiming deduction? Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Ise property in question:
tI Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Haubstadt 26-19-31-301-000-110-009
Does applicant reside on p perty? Assessed value of the property as of current year assessment date(May not exi rel$200,000 for Over 65 Deduction or$199,999
Yes ❑No (counting just the homestead site)for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199,999(all 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 Decentppper.31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions?rycf If Yes, deductions?
IQI Yes ❑No 5 Tor
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Have you filed for deductions in any other county? If Yes,what county? l.Y -
,_ Ct
❑Yes NINo / c1. Z.Z.-2.LC� _
I/We certify under penalty of perjury that the above and fore gin rmation is true and correct.
Signature of applicant ////��2^e1 Date(month,day,year)
Address of applicant (number and tie city,state,and ZIP code) ;/4�/ �.��� / /( �" i/7/-3
Signature of authorized representativese /�`// (/`� 'Q`�` J /� uate(month,day,year) �7`- �7
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor r� Date(month,day,year)
.“ .L•C A'VQ l.l�Th CIA-L m J\, Lk-c -(" 4_
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F ILED
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,, APR 21 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON BOUNTY AUDITOR