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Age_Carlisle „0-!--44, APPLICATION FOR SENIOR CITIZEN MM. MEM \' PROPERTY TAX BENEFITS TOWNSHIP Slate Form 43708(R15/1-20) So,� ig r�,0102-2 Prescribed by the Department of Local Government Financei 1 (`' /J 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 CountyAuditor of the county where the property is located. Filing Date: Form must be completed and signed by December 31 and tiled 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 al that apply.) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name o pplicant(owner or con ract buye — Is applicant the sole legal or eq a owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. Yes ❑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)? ❑Yes Lgtdo 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 [1]NO Address of contract seller(number and street,city,state,and ZiP code) Is the p rty in question: Real property ❑Mobile home(IC 6-1-1-7) Taxing + r t Key number/Legal description Record number Page number . ()C-g 2L-ll-/2- 20 - ©OZ. L23- dzF' 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 Y El 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 r 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 a year $ Have you filed for any other deductio If Yes,who deductions? ^ / Yes ❑No �a e siexi Have you filed for deductions in any other county? If Yes,what county? ❑Yes Lj2co PG(.CJQr 5 -e 14I- li'f I/We certify under penalty of perjury that the above and foregoing information is true and correct. gnalu o pplicant Date(month,day,year) „rt.. q-/1-2023 A dres applicant (number�qd city,st�{e,and ZIP co �.� f L 4 e 7 �'�{/ stre t, jEn Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Si natu CountyAuditor A Date(month,day,yea FILED APR 11 2023 & JM n J DISTRIBUTION: Original-CountyAuditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR