Age_Carpenter �•�•=.4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS ��``��
7\ � State Form 43708(R15/1-20) \(1,., G Y� "�v��
�' Prescribed by the Department of Local Government Finance �/cb tr-)I ` . .-, tt,0 a- P z,7
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
Type of benefit requested(Please chec II that apply) ,—,/
Over 65 Deduction from Assessed Valuation t�f aver 65 Circuit Breaker Credit
Nam of applicant(owner or contract buyer)
la-- : C °- — .
Is applicant the sole legal orreq` able owner? I ,what is h /her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
L 'Yes ❑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?
G:lArAs ❑No
Name of 4on a�er Has applicant owned or been buying the property under recorded contract for
V�`\] at least one(1)year before claiming deduction? Y_I Ye�-
s ❑No
Address of co tract seller(number and street,city,state.and ZIP code) Is the property in question:
r ,-R'eal property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
2(-YDC-5S — 00—OM- 1_. 6— OLX •
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
es ❑No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
properly]for the Over 65 Circuit Breaker Credit initially applied far alter December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
$
Have you filed for any other deductions? If Yes,what deductions?
es ❑No N
Have you filed for deductions in any other county? If Yes,wh t county?
❑Yes tL;14Go
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of appli nt I Date(month,day,year)
s1 _ ant (n er and str et,,city, tss and Z code) — La-{lk 0
Signature of authorized representative/ Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
1 � R 0 �_�� CL l� •�� �� - 10 1, 1 Zz
F LED
our 1 4 202 "
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON�t e COUNT D