Age_Vessels •
„ %, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
: "-\o PROPERTY TAX BENEFITS
,i► Slate Form 43708(R15/1-20) F'r.
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� , •� Prescribed by the Department of Local Government Finance I' �� Z rail 0V.% p2 3
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.
Type of benefit requested(Please check all that apply.)
L-ever 65 e-:. .• . - - -ssed Valuation ['6ver 65 Circuit Breaker Credit
Name of applicant(owner or contract bu -r)
3-0'e‘i . -Di 0.vc1 Vt55-%lS
Is applicant the sole legal or
equilabl-owner? If No,what is his/her exact share or' erest? If owned with joint tenant or tenant in common,indicate with whom.
El.-Yu�S El •
If name on record is different than that of Tpplicant,indicate below. Do all joint tenants or tenants in common reside on the property?
Lt'�7es ❑No
Name of contract seller Has applicant owned or been buying the property under record d contract for
at least one(1)year before claiming deduction? ES'e s ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
[ eat property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
c} . '3cc cL (26-14i( -30y—oat . Ii g- Oo
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
re
I�res ❑No [counting just the homestead
❑No 1-lt3vv`c5 It e ,
Have you filed for deductions in any other county? If Yes,what county?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
*Signal . ,:e0g plh Date(month relay year :
.r-4 0, G i � 9/ 7/aoa3
Address of applicant (number and street,city,state,and ZIP code)
5,3 I V t'e 5/` I+ arc,^cL _A/ 1476 qeT
:Sin tune of.authorize e r "''CltatiG'.' Date(month,day,year)
Ad ess authorized representative (number and street,city,state,and ZIP code) '
Signatur of County Auditor Date(month,day,year)
/v12 a ,,21.----- 3/7/a3
FILED
MAR 7 2023
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSONI�y AUDIT
OR