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Age_Lloyd 4�67:7! , APPLICATION FOR SENIOR CITIZEN TOWNSHIP MEM a�. r:.'2 = PROPERTY TAX BENEFITS Slate Form 43708(R15/1-20) I 0 DNO �'ieie f 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. Type of benefit requested(Please check at apply.) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Namee o faplicanl(owner or contract buyer) Goy >IL1a tenant in common,indicate with whom. L.211e7- ❑No If name on record is different than that of applicant,indicate below. l Do all joint tenants or tenants in common reside on ithe property? Eli Yes • ©1 Name of contract seller Has applicant owned or been buying the property under recorded 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 the property in question: �cf' al property ❑Mobile home (IC 6-1-1-7) Taxing district-- Key number/Legal description Record number Page number i'I"a.rl 5e0 z6-i 3- /3- 20/ - d::)a)© - /63-to.5 Does applicant reside on propert 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 of age or more on December She year $ (� Have you filed for any other deducti If Yes,what deductions? Yes ❑No yJ Have you filed for deductions in any other count If Yes,what county? ❑Yes ILENo I/We certify under penalty of perjury that the above and foregoing information is true and correct. S' nature of applicant Date(month,day,year) Address of applicant (number and stree ity,stale,and ZIP cod r ya3 w n h 19/Wjf 1747Cr` 19 Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) • Si nature f ounty uditor �J Date(month,day,year) FILED APR 0 6 2023 DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ` C �` K�^ GIBSON COUNTY AUDITOR U