Age_Shaw .��-��, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7� PROPERTY TAX BENEFITS
l{i l: State Form 43708(R15/1-20) Gib son Coto mbn. as
.1."--ilia 1 Prescribed by the Department of Local Govemment 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 arid payable.
See reverse side for additional instructions and qualifications. ''.(
Ej,erver 65 Deduction from Assessed Valuation Ei t 'ver 65 Circuit Breaker Credit
Name of applicant(owncr or contract buyer)
C' I.c e A . w
Is applicant the sol gal or equj,table owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
PUWes ❑No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on t roperty?
es ❑No
Name of contract seller Has applicant owned or been buying the property under record contract for
at least one(1)year before claiming deduction? es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Isail-Real
thee roperty in question:
L'Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal descrjation Record number Page number
Co IL,iV`c; a G- I L(— l e-zo i -D6d. I R G - OIo(v
Does applicant reside on pro,- y? 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 ste)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
,?Yes ❑No property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 yea ( age-, more on December 3>of the year
$
individuals spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?� � l
1 1-e's CI No V-kb�l�e'5 T
Have you filed for deductions in any other county? If Yes,what county?
Dyes El No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicanter / // <\y� Date(month,day,year)
Address of applicant (nu and street,city,state and ZIP code)
%t 4 U(a C 1sa Oe L- i C t \-Ill .A)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Audit r Date(month,day,year)
�7/ If I y/a-....
FILED
NOV 4 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ,7`Y a.liYtal.Eteirld)
GIBSON COUNTY AUDITOR