Age_Beumel •
APPLICATION FOR SENIOR CITIZEN COkINTY TOWNSHIP YEAR
r $ PROPERTY TAX BENEFITS
State Form 43708(R15/1-20) y01 Wk
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.) . •
Ffiver 65 Deduction from Assessed Valuation' 1 .15"er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
L - 13 e..41 rr)e._ I
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant nant in common,indicate with whom.
0 Yes El No A
If name on record is different than that of applicant,indicate below. Do all joint tenants or te nts in common reside on the property?
E Yes 0 No
Name of contract seller NIA Has applicant owned or been buying the property and r recorded contract for
iv n
at least one(1)year before claiming deduction? .1 ri Ljr-I
Yes 0 No
Address of contract seller(number a d get,city,state,and ZIP code)ft Is the property in question:
. Real property 0 Mobile home(/C 6-1-1-7)
Taxing district Key num r egal description Record number Page number
2.c- / 5- 06-7,4o _0 `0. 7 --0 0 9
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 fall Indiana real
ZlYes i]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
Have you filed for deductions In any other county? If Yes,what county? AUA
['Yes KNo
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
r applicant .
n9n2/ A) 0 f, -3_,P.,ituryLe.. Date(month,day,year)
Signatu
Address applicant (nu bar and street,ci ,state,and ZIP code)
5-I 3 5 , "i3 -i-h ve. Na.L.4175-tet.d1 HO (-170 39
J
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
a. \,, (0-AL /
F.,/LE I
MAY 0 3 2023,1
uzzia,pirez4,614)
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer