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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS n^2?
S .... State Form 43708(R15/1-20) (/�1 J�,n O 0 ! v
✓' 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 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 Over 65 Circuit Breaker Credit
Name of app cant(owner or co rac�nu�y-er)
lxV) -u \"'1N\C�.
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.
❑Yes ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common resid o e property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under co d 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 a roperty in question:
eal property ❑Mobile home(IC 6-1-1-7)
Taxing district Kxe nup++ber/Legal description Record number Page number
0S Lb -B-1c1 20k- b vo 2 ZZ- O O
Does applicant reside on p Assessed value of the property as of current year assessment date(May not exceed$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[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 onls or more on Dece be 31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other de Yes If Y�iat deductions?,_ T
s ❑No -11'C'Have you filed for deductionsother,,����,����nnnn......,,,,u(u(uu((ttff,,,�ty? If Yes, at county?
❑Yes No
I/We certify under penalty of perjury t t the above and foregoing information is true and correct.
X/ Signature of applicant p- Date(month,flay,year)
Add_ress of appli nt numbe street,city,state,and ZIP code) kiv9
•
Signature of authorized representative / Date(month,day,year)
Address of authorized representative (numb
er and street,city,state,and ZIP code)
Signature of Co unity Au r D ( v./kith.d , a!�
FILED
MAY 4 2022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR