Age_Oneal �4T• APPLICATION FOR SENIOR CITIZEN
l q\ PROPERTY TAX BENEFITS COUNTY TOWNSHIP YEAR
d, efr—0 g State Form 43708(R15!1-20)
'4�•' Prescribed bythe Department of Local Government Finance 1 10 g�� �r���' n ��
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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
ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract er)
Do.n\e 4-. be Ur* \
Is applicant the sole legal or equit le a is iclhar PYart share or' ? If owned with joint tenant or tenant in common,indicate with whom.
ripeg f]No
1 If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the prbperty?
❑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? [;.yes- ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the erty in question:
eat property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
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 5199,999
❑Yes ❑No [counting just the
$
Have you filed for any other deductions? If Yes,what deductions? \\
s ❑No i-� � G [e .t e� S a�,tt\.\'t � 1 `.
Have you filed for deductions in any other county? If Yes,what county? J A-Dyo
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❑Yes [ot� 2 �l
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l/We certify under penalty of perjury that the above and foregoing information is true and correct. icv‘
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Address of applicant (numbe and street,city,stat and ZIP code)
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11 16 aturedia,,uthorizes rep esentative r Date(month,day,year)
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Address of authorized representative (number a d street,city,state,and.P code
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Signature of County Auditor Date(month,day,year)
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MAY 013 2023 , .
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Yhe,f)iiiLl a. iitra .
GIBSON COUNTY AUDITOR
