Age_Sloan s... APPLICATION FOR SENIOR CITIZEN
6 '_' 1 PROPERTY TAX BENEFITS COUNTY TOWNSHIP YEAR
St� f11 State Form 43708(R15 I 1-20)
F . '. Prescribed by the Department of Local Government Finance V t\ n C � D, 3
,1 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. ^ `
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52't�ck�ver 65 Deduction from Assessed Valuation 2<er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the sole legal or equitable oti ? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Eyes ❑No
If name on record is different than that of applicant,indicate belgw. Do all joint tenants or tenants in comrhon reside on the property?
❑No
Name of contract sell r Has applicant owned or been buying the property under recorded contract for
�
1 \c 1�` Ly at least one(1)year before claiming deduction? r ,-res/ Ill No
' 1 l
Address of contract seller(number and street,city,state,and ZIP code) Is the property� in question:
Lfd'1-teal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
CFraINCL- C-C) . ate- 13 -l-1 - -- -co -cU2,-
Does applicant reside on propeV Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
g-fes property]for the Over
Have you filed for any other deducti s? If ,what deductions?
Yes ❑No
Have you filed for deductions in any other count If Yes,what county?
ID Yes D'No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of aplicant Date(month,day,yeeayr)�
-Address o a ptn nu er and str et,city,state,and P code)
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Address of authorized representative (number and street,cit at ,and ZIP code)
Signature of County Auditor Date(month,day,year)
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FILE -
FEB 21 2023 \
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GIBBON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-StampedCopy-Taxpayer