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Age_Thompson !_1-4.*.0. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR g ':=% �, PROPERTY TAX BENEFITS '' �!i; Slate Form 43708(R15/1-20) 1- +��'•f Prescribed by the Department of Local Government Finance G I CJ SoVI a-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. Fling 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. tsigge; Type of benefit requested(Please check all that apply.) [j er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) An ce I fR MA o mpSoil ?a,ne F S C GL©nipSoit Is applicant the sole legal or equ" ble owner? If No,what is his/her exact share or interest? V 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. Do all joint tenants br tenants in common reside on the property? Ej-Yes ❑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? [I'Pes ❑No Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: [heal property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number ��1At..morl aG- Ia-\ -tot- coo. s'//,-eQ Does applicant reside on properly" Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 BY-es ❑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 ( ' Yes ❑No RC,'N-esIto,d Have you filed for deductions in any other county?ty If Yes,what county? ❑Yes { ' I/We certify under penalty of perjury that the above and foregoing information is true and correct. ignatur�pt pp i ant p• 6 ate{a non"t id y.....ar)fi Address of applicant number and street,city, ate,and ZIP code) / Y0 t, t„ . ert,,E:d c gi 54 - �',yr_e.fort I JtJ `{ >O ?C_ `ig as ul:eat/'a�ith`miedtrep`?eseia(ativ€*�" ' Date(month,day,year) .gyp Addr, s of authorized representative (number a d street,city,state,and ZIP code) Signature of County Auditor „ ,l,�� G ' _ ��ate(month,day,year) N(� �{Mf V�jtA�1�t,�[� "0(43 FILED APR i02023 2,.miz.1L a J/(c GIBBON COUNTY AUDITOR DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer