Age_Foley �.^�,.,, APPLICATION FOR SENIOR CITIZEN Cf UNTY TOWNSHIP YEAR
" PROPERTY TAX BENEFITS /�\ (^
�� `t�� State Form 43708(R15/1-20) ( JI C`\ V 25, �22
\ `• Prescribed by the Department of Local Government Finance `- J v� ��JJ
•
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_
FilingDate: Form must be completed and signed by December 31 and filed with
See reverse side for additional instructions and qualifications.
Type of benefit requested(Pleas e��ch1eck all that apply.)
exact sharer interest? . J - If owned with joint tenant or tenant in common,indicate with whom.
Yes El No
If name on record is differ than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
❑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 t property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district g Key ber(Legal de {iptio�� �0�� —b Record number Page number
Does applicant reside on o rty? 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 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 f a or more on Dee
$
Have you filed for any other de`ju tions? If what deductions?
E 1Yes ❑No J\
Have you filed for deductions i other c u ? If Yes,what county?
❑Yes No
I/We •"ii„u •=r penalty of perjury t at theabove and foregoing information is true and correct.
a re of!pp •••nt '\ ( Date(month,day e
AIN
Address of applicant number and treet,city,state,and ZIP de)
RlCt t\ \5cft -
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of Coun udit`or o^ or ` �\ � Date(month,day,ye y \ FILJJj )
MAY 1 1 2022
GIBS COUNT Y gU OR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer