Age_Mitchell APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
\
State Form 43708(R15/1-20)
-", Prescribed by the Department of Local Government Finance k_SQ‘r 0 ZS 'C)2_2
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 k all that apply.)
Xv
Name of applicant(owner or contrOve,rr)65 7 IT;.. '• from Assessed Valuation Over 65 Circuit Breaker Credit
y
t
Cilepd c r151-1011
Is applicant the sole legal or equitable own- - ,.,w at i his/her ex ct hare or interest? If owned with joint tenant or tenant in common,indicate with whom.
Eves 0 No
If name on record is differerpt than that of applicant,indicate below. Clo all joint tenants or tenants in common reside on the property?
0 Yes Ci]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?
1:1 Yes E No
Address of contract seller(number and street,city state,and ZIP code) I-t • .roperty in question:
V Real property 0 Mobile home(IC 6-1-1-7)
Taxing district 0 22 • ITzumbler/Legal description _001 . 2 2 . Record number Page number
Does applicant reside on op ? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
Yes Li No property)for the
Have you filed for deductions i an other ou y? If Yes,what county?
0Yes EXNo
. '
I/We certify under penalty of perjur tlet the above and foregoing information is true and correct.
v Signal re o pplicant
/ • Date(month,day,year)
(\ 7
Address of applicant jnumber and street,city,state,and ZIP code)
3Ut Prbbi-vc_ -s-k .fl Av.,- Dv) - 9 9--C T\D.
Signature of authorized representative -r Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
1
Signs County Au itor Date(mon
FF.: El,
APR 11
\-1\
i a, ti -
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer