HomeMy WebLinkAboutAge_Arbuthnot APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
iV41:1 State Form 43708(R15/1-20) ' CO/l/WOO
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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 all that apply.)
g•eger 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
CJA F ArboNAke\-0 --
Is applicant the sole legal or equitable owner? If No,what is his/heriexact share or interest? If owned with joint tenant or tenant in commbn,indicate with whom.
[ZY-s1 EINo
I If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the prbperty?
EI 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?
1:41.6-s El No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Ejj. al property LII Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
CO/UNA\tit ce_ 96.-lei- 67— qev,- ao • Y/41- Oe7C0
Does applicant reside on property? 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 El No 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 31 of the year
Egtre7 ON° f-t ine_s\-40.A
Have you filed for deductions in any other cour92 If Yes,what county?
EiYes R'ho
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
eign.17r3C11.aPp icant hz_elettivizee. 0
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'Address of applicant (number and street,city state,and ZIP code)
lk .S IPagE 064-1AAIAI 7_-,41 1(76 6 e)
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signat re of ounty Auditor Date(month,day,year)
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MAY 0 3 2023
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GIBSON COUNTY,AUDITOR