No preview available
Age_Smith (9) `o�:=^,r• APPLICATION FOR SENIOR CITIZEN � COUNTY TOWNSHIP YEAR ��'" PROPERTY TAX BENEFITS State Form 43708(R15/1-20) 4�+ ,e`Y''/ Prescribed by the Department of Local Government Finance MIEll 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 Over 65 eduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of applicant(owner or co rac uyer) V 1.. S 1 ' I Is applicant the sole legal r e stable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. Yes ❑No If name on record is diffe nt t n that Qf applicant,indicate below. Do all joint tehants or tenants in common reside on the property? ❑Yes II No Name of contract seller Has applicant owned or been buying the property under ecor d contract for at least one(1)year before claiming deduction? Yes ❑No Address of contract seller(number and street,city,state,and ZIP code) Is property in question: Real property ❑Mobile home.(/C 6-1-1-7) Taxing district Key number/Legal description Record number Page number 0 Z 26-12 a-i- (-\(A-ono 0- -0 29. Does applicant reside on p p rty? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 Yes ❑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 agor more on Decemb r 3 f the year ❑Yes o I/We certify under penalty of perjury tha the above and foregoing information is true and correct. 1 Signatureapplicant , /J Date(month,d ea/9t7/ 2-3 Ad ss f pplicant (numberenn r�ylstate,and ZIP e) / � � t .`2,-) 1 il '-k r Dn r k --6 Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) i Signature o nrrAuditor� �\� '`n ISCA D`te t year) ) FP I) MAR 2 9 2023 /1u�1ur�( &.,i/11 ,4) DISTRIBUTION: Original-CountyAuditor; File-Stamped GIBBON COUNTY AUDITOR gCopy-Taxpayer i