Age_Osborne �t.�,*• APPLICATION FOR SENIOR CITIZEN
�,i�,. �.� COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS II-
a' li State Form 43708(R15/1-20) 6 I o 50rt an Son
• ens d Prescribed by the Department of Local
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�chheckck all that apply)
L�l t7ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
l�tm At 056orne
Is applicant the sole legal 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.
�tes ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common residei on-7,��the property?
Ei res ❑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? 11.-feS ❑No
Address of contract seller(number and street,city,state.and ZIP code) Is the property in question'
E tcr-eal property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
o),„sop? -Qa- yov-too/ 6 o..)z-f
Does applicant reside on propert Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑No (counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999 fall Indiana real
es 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 December 31 the year
Yes No 51-earf
Have you filed for deductions in any other county? If Yes,what county?
❑Yes I_y'No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
401
Date
m/Pf,�th, y year)
� <
plic n umber and street,city slate,and ZIP code) ///
4/ a s tz a s E-(&-.64.,c(f
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signatur of ounty Auditor Date(month,day,year)
FILED
MAY 6 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR