Age_Gray M -�., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e- `: PROPERTY TAX BENEFITS p
Sl. State Form 43708(R15/1-20) 1 b `C;r(-,- Z
d. 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
Type of benefit requested(Please check.-ell that apply)
agiOver 65 Deduction from Assessed Valuation IZ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
`—�-^NV, v c v f o ed with joint tenant or tenant in common,indicate with whom.
DI-YIs applicant the sole legal or equitablener? If No.what is his/her exact share in ref. � F
es ❑No ■■ _
Do all joint tenants or tenants in common reside on the property?
If name on record is different than that of applicant,indicate below. fl�1gg ❑No
Name of contract seller DEC 6 Haazzant owned or been buying the property under recordedr--��contract for
at�least
tone(1)year before claiming deduction? I�Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) L .v Yt .e�. Is the property in question:
GIBBON COUNTY nab Real property ❑Mobile home(/C 6-1-1-7)
UNTY AUDITOR Record number Page number
Taxing district , Key number/Legal description
Pr- ,r.c_e.r+o0 ae-( -0-7_/ o• - 003 . a(-(� - ba5
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
(counting just the homestead
individual's spouse.)See reverse for details.
Have you filed for any other ded�uc,tio�ns If Yes,what deductions? ^ `�G` �
L,Y�S ❑No }(G`�v�C S�- ',I 1-b b
Have you filed for deductions in any other couptya- If Yes,what county?
❑Yes Bi*N-/o
I/We certify under nalty of perjury that the above and foregoing information is true and correct.
Signature of applicanGlti , Date(month,day,year)
�° 7 1a - 6— GI,'Z
Address of applicant (number and street,city,state,and ZIP co
a n L,J 6 e r-.)c e S-}- c c 4-0N L Ai 7
Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city state,and ZIP code)
Date(month,day,year)
Signs ref County Auditor ^ laV /
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer