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*•a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
.!; State Form 43708(R15/1-20) //,, b ( \n��+h c oc
<�� 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.
Type of benefit requested(Please check all that apply)
❑Over 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
Name of applicant(owner or contract Buyer)
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.
L s ❑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?
Ea-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? a-1 ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the propertyin question:
Lg heal property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
C%AC..e(-en aG- -07-3aY- 603. 3D.5-- 01-&
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
es ❑No [counting just the homestead site]for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December,--,�s ❑No 31 of the year
Have you filed for any other deductions?�--,I/ If Yes,what deductions?
LI ❑No A.t 0) 1-(.00"e-S
Have you filed for deductions in any other county?/ If Yes,what county?
❑Yes EII1
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sign�aeture of applicant 4,,- Date(mont ,day,year)
'
VOI4c_.) eir i9-1a0Q .
Address of applicant (number and street,city,state,and ZIP code)
G '$ 5 HAr-- 5+ 7c-:r...e-k-ov% =c-.N U7 4 70
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signat r of ounty Auditor Date(month,/
day year)
44L,ED
AUG 17 2022
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer