Age_Skelton (2) ,_, E� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
L. PROPERTY TAX BENEFITS 1 �^State Form 43708 R15/1-20 !" 2 Z`,, .SO n
" Prescribed by the Department of Local Government Finance
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.
Over 65 I•suction from Assessed Valuation L�(Over 65 Circuit Breaker Credit
Name of applicant(owner or con act buyer)i � ���� +r r
clue^ al( o o h►1.a, -
Is applicant the sole legal or equitable owne If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Oyes EN.
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
III Yes El No
Name of contract seller Has applicant owned or been buying the property under r co ed 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 t,hc}property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district 0�� •
Key number/Legal description Record number Page number
kt—12-01—t-103-Q03.0 00. 028.
Does applicant reside on pro.•rty? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
(i1 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
individual's spouse.)See reverse for details.
Have you filed for any other ded ctions? If Yes, t deductions?
]Yes ❑No , t . -Vb
Have you filed for deductions(nay other)i(ty? If es,what county?
❑Yeso
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of appli,carj.t.\11
Date(IP
��y'' _ J ye'L``/�
Address of applicant (number and street,city,state,and ZIP code)
xk:ignat . th ed r pc.7 ::2 \ Date(month,day,year)
Address of authorized representative (number and street,city,state,an Z code)
Signature of Cou�tyAu, di4t it� r Dale•( onth, ay,year) 3
� 1! FILED l fiVn ..
APR 0.4 202
( ..0 a. 1r1'
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer