Age_Crooks APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
wkIrsiii) State Form 43708(R15/1-20) f k
010 (1.vl O(Uilik\y61/4 c;s',•---ziTa---'.;'' Prescribed by the Department of Local Government Finance C 23
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. ',,---
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Les [1]No
. _
If name on record is different than that of applicrt,indicate below. Do all joint tenants oritenants in common reside on the property?
[A-re-s E 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?
PI/es 0 No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
1 `1:1—eal property 0 Mobile home(IC 6-1-1-7)
Taxing district . Key number/Legal description Record number Page number
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
kg?fes [I]No [counting just the homestead site]for the Over65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
r
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 December 31 of the year
1Dtes 0 No KO Wke.4)'VEtk-Ck
Have you filed for deductions in any othe oun . If Yes,what county?
['Yes o .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Ad f applicant (nu r and street,city,state,and ZIP code)
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature ogp tky Auditbi- Date(month,day,year)
- 3/6/G23
FILE
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MAR 6 2023
Yi2„A4Le a P(roilin4)
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer