Age_Thorne „ , �4 APPLICATION FOR SENIOR CITIZEN c�UNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS ///��� r�/lj
j' State Form 43708(R15/1-20) C Cry I 0 v ` 10 2_2_'
-- Prescribed by the Department of Local Government Finance Q c�V 1
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. ?” _
Over 65 Deduction from Assessed Valuation l vver 65 Circuit Breaker Credit
Name oY.Opjicaeryr or ,a Gyo� - ��\\
Is applicant the sole leg 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?
El Yes ❑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 property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district 04 • Key number/Legal description‘2—01—‘-k130 — OV c�,^ 6-
Q O Record number Page number
'+Q
Does applicant reside on x
rty? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$f 99,999[all Indiana real
Yes ❑No prope ]forthever65CircuitBreakerCredit initiallyappliedforafteremr312019.)Sreversefordetails.Is the applicant 65 years or more on Dece erp of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other de ons? I what deq►yVc.yons?]J'�'� t t y s_�11 1
Ld Yes ❑No S t , 1 C. �/
Have you filed for deductions i any other c un y? If a,what county? CCJJ �v
❑Yes Jo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Date(month,day,year)
Sig lure of appl;cant
X Adddrree,`ssss oof,> applicant�mbnd s(reef,city,state,and ZIP code)
✓`� O �So N _. -1 Date(month,day,year)
Signature of authorized representative f
Address of authorized representative (number and street,city,state,and ZIP code)
Signat re of Cou Au=itor r (� ) Date(mon d ) ar�J 2 •
FILED
APR 2 7 2022
iy)2 C a.UMM .&4&
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR