Age_Baumann C�•*,,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a PROPERTY TAX BENEFITS
iltoo. ' State Form 43708(R15/1-20) \_ (-
''s Prescribed by the Department of Local Government Finance �tb l T-` e4D z 0-Z.Z.
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.
'ever 65 Deduction from Assessed Valuation Ni<eC65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equit owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es ❑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 contrac , Has applicant owned or been buying the property under recorded contract for
f��l at least one(1)year before claiming deduction? ❑Yes ❑No
Address of contra t seller(number and street,city,state,and ZIP code) Is the perty in question:
Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
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Does applicant reside on propert Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
es ❑No [counting just the homestead site]for the Over ,65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on Decemb,er,�31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions? �
1s ❑No -` Q h(1��+e-`^ -1 .
Have you filed for deductions in any other county?? If Yes,what county?
❑Yes [il..1
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
ig re ap licant Date(month,day,year)
Address of applicant (number a d street,city,state,and ZIP code)
Signature of authorized representative Date(month,day,year)
' Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
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FILED
DEC 2 8 2//0--22��.D•
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer