Age_Heitz ,(wF-r!ho, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e07 �-4 PROPERTY TAX BENEFITS /� ,
31` li State Form 43708(R15/1-20) L 11' 5O1 f ?F'\ f\ce/L"VI .,:,
'' 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. ,
CfrOCer 65 Deduction from Assessed Valuation [l'�er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
.Y,-net- kAe4.-e"
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.
1-31"6-8- ❑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?
❑'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 the j2....roperty in question:
Qi"kreal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
O.kr\xinn --f -D7-LIN- oor. 1 5 - Oars
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
❑Yes LI No [counting just the homestead s,tej for the Over 6i5 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property)for the Over
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductio s? /O Q��
D'Y-S El No '1.� Ii✓t r io,�„, I
Have you filed for deductions in any oth coun . If Yes,what county?
❑Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant / Date(month,day,year)d/// �,/ 092_2—
Address of applicant (number �({ �'and street,city,state,and ZIP code) _ /� b Q
I IS 5 GI b �I ".sn ``\`--e�n 1 "./ Y Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of/ _ CoylntY Auditor( \ I / Date(month,day,year)
SL y.J\/`Q__Y�i . /(/// i c2i ate/ .:=,..a
`�.;�A . ��, w, � ) _ FILED
1",,,,,,,N,‘
OCT 21 2022
C2 VZ IO2� 21 -
-Tax a ` ' //�
DISTRIBUTION: Original-County Auditor; File-Stamped Copy Taxpay `� ��. nd)
GIBSON COUNTY AUDITOR