HomeMy WebLinkAboutAge_Reeves �.s,E. e.4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
r� \ PROPERTY TAX BENEFITS 4 2/�
1� State Form 43708(R15/1-20) (/�J,\ Snn O Z D ' v
s ,w,i-4- 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
Record number Page number
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Does applicant reside on)5<,op rty? 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 prorty]fortheOver
individual's spouse.)See reverse for details.
Have you filed for any other de tions? If Is,what deiuctions?
Yes ❑No I1.}, 11�iC0.
Have you filed for deductions a otherpc ty? If Yes,what county?
❑Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
applicantDate(month,day,year)
Si a app'
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Adgressoff applicant er and street,city,st/7/1.0.42(2t ............__________
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',, IILL.. O 1� \ - • Q t'h�r.— �i.��"e. � r6�
Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and
ststreet,
�city,state,and ZIP code) 6eli%�7
�J I Date( t�•, c
Signature of County Auditor ‘1.--- 'L)/
FILED
DEC 012022
GIBSON COUN 'i AUDITOt
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer