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Age_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 ROver 65 Deduction from Assessed Valuation �[J Over 65 Circuit Breaker Credit Name of applicant(owner or contuyer) M`- ,ay �Te ac Is applicant the sole legal or equitable owner? If No,what is his/her exact sh are a or interest? If owned with joint tenant or tenant in common,indicate with whom. ❑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? ❑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) I t e property in question: Real property ❑Mobile home(/C 6-1-1-7) Taxing district ©2—S Key number/Legal description Record number Page number Z6-\2- «-3oLi-pot. byo -o'7� 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' lz/Z-/7L Adgressoff applicant er and street,city,st/7/1.0.42(2t ............__________ e) , ',, 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