Age_Neufelder Cl
q. APPLICATION FOR SENIOR CITIZENPROPERTY TAX BENEFITSCOUNTY TOWNSHIP YEAR
State Form 43708(R15/1-20) riurPrescribed by the Department of Local Government Finance t hso�1 T �� 0
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
Type of benefit requested(Please check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) R / k F
(be 461-mi.
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.
'es ❑No
If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the proplerty?
ards El 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? [ 'es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
D-Rggproperty ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
rt. . rc.,r•ck owo - (q-let-- /n 1-000.`) S'I - h D c,
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
s ❑No [counting just the homestead sitel for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property]for the Over
Eyes ill No (—t'Cvry e.54-ec c
Have you filed for deductions in any other county? If Yes,what county?
Elves �10
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature.oFpptjcanWr ,,Date(monthTday year)
43,1,6("41. - /1442(4,7 , .......„,702,...7 ,...rar.t„,.•
Address of applicant (number and ieet,city,state,and ZIP code)
Sigga� e..off-authorized reprae�t,Tv , Date(month,day,year)
I 7Ie ki �.I 0444 L. rY 4
Addr ss o authorized represe alive (number and(Street,city,state,and ZIP'code)
Signature of County Audit r Date(month,day,year)
/d1^k1
42
, C�d - 3/0 1 l'a
FILED
MAR 21 2023
DISTRIBUTION: Original-CountyAuditor; File-Stamped Taxpayer !' """�� ,�na�
gCopy- GIBBON COUNTY AUDITOR