Age_Byrns .,.R-*, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
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A .,� State Form 43708(R15/1-20) J Q f/�` 0 p
��,-d' Prescribed by the Department of Local Government Finance J
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)
Ruth Ann Byrns
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
Do all joint tenants or tenants in common reside on the property?
If name on record is different than that of applicant,indicate below. IZ 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? II Yes ❑No
N/A
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
®Real property ❑Mobile home(IC 6-1-1-7)
Taxing district
Key number/Legal description Record number Page number
Patoka Township 26-11-07-400-000.253-027
Does applicant reside on property? 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$199,999(all Indiana real
®Yes ❑No property)for the Over
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
EYes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
❑Yes ZNo
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
t/` tC(month,day,year)
Signature of applicant Da
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Address of applicant (number and street,city,state,and ZIP code)
324 S 575 W, Princeton, IN 47670
Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city,state,and ZIP code)
Date(month,day,,year)
Signature of County Auditor k (P/ t n 1,-.1 ./\ .
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR