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Age_Robb .a R,r.,ar APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR a/-';`I PROPERTY TAX BENEFITS ill _3ti State Form 43708(R15/1-20) / •• SQ ''��4<' Prescribed by the Department of Local Government Finance (7 1� �(� V��E� �3 yew 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 all that apply.) L-.Aaer 65 Deduction from Assessed Valuation ©$ver 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) Non CAA C pob-er÷- R0136 Is applicant the sole le I or equuli able owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. ldYes ❑No If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property? LJ,lres ❑No Name of contract seller Has applicant owned or been buying the property under recorded contract for al 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: E 'rceal property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number r(- 1\c2td n c2 —0a—!7—loa - OO . 9o3- a� C Does applicant reside on propery?, Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999 es [II 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 alter December 31,2019.)See reverse for details. Is the applicant 65 years of age or more on December 31 of a year / �p� Pies ❑No Ns3MeUe i.. Ator{ J JE__ Have you filed for deductions in any other county? If Yes,what county? El Yes El]No I/We certify under penalty of perjury that the above and foregoing information is true and correct. l Sig naturedt,app leant: 1 /') 1�4jt� °L�-1�- month•day, earl" Address of applicant (numb rand street,city,state,and IP code) i1Ua 8. ph:o PrinCiekar ,n/ 476 ?a Si natoreef:authonzed re rese a�7 Dte thd ear� D r dm ' (n % Address of authorized represen ative (numb nd street,city,state,and ZIP code) Signature f/Suditor I ,�tiJl,1�`V V Date(month,day,year� f /9V,1,/I _ �� FILED APR 0 6 2023 j e/ GIBSON' CUNTY AUDITOR DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer