Age_Sensmeier M =E0. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
°` S;: PROPERTY TAX BENEFITS l f! n
ai' State Form 43708(Rib/1-20) C _S o C� �L" .
Prescribed by the Department of Local Government Finance J
�.i.:„ 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
Type of benefit requested(Please c eck all that apply.) '� `
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Na o applicant( S
wner or contract uyer)
10Ve^ .
/t. or equitable Sen r+l - ems/
Is applicant the sol lega or equitable 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 on the property?
❑Yes El 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 h property in question:
Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number Legal description Record number Page number
O6 [ / tr/ I O 00o. 8 - 6
-
Does applicant reside on pr rty? Assessed value of the property as of current year assessment date(May not exc �1$200,000 for Over 65 Deduction or$199,999
Yes ❑No (counting just the homestead site]for the Over 65 Circuit Breaker Credit reserved 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 f ag r more on Decem er 1 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other de u Lions? If Ye h deductio ?
Yes ID No S
Have you filed for deductions i a y other ly? If Y s,jvhat county?
❑Yes No
I/We certify under penalty of perju that the above and foregoing information is true and correct.
X4Si natur of ap lica t / , Oat (moot ay,year)
/�( �,12, , - Z 2
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Address of applica (number and and street, state,and ZIP co \,1--� /'( i O
I0Z w t' k S� FT `1 .t.h — — -t -�j k
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city state,and ZIP code) 1).L ,d
Signature of County AuditorNaidik (� Date(m L. • d , Z
FILED
APR 2 5 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer lyI_ 1 N�/
GIBSON
COUNTY AUDITOR