Age_Pugh t.T•r• APPLICATION FOR SENIOR CITIZEN
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PROPERTY TAX BENEFITS
COUNTY TOWNSHIP YEAR
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x'riofr;� Slate Form 43708(R15/1-20) 'NO{�CA
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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 due and payable.
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
equit le owner? If No,what is his7t er exact sharelor interest? If owned with joint tenant or tenant in common,indicaterwith whom.
es ❑No
i 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?
❑Yes ❑No
Name of contract seller I Has applicant owned or been buying the property under recorded contract for
1 at least one(1)year before claiming deduction? 111 Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑Real property ❑Mobile home(iC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
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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
❑Yes ❑N o (counting just the homestead site)(or the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property)for the Over
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des ❑No HbtaesV•eoac�..: - .. MAY 01
Have you filed for deductions in any other coounty?/ If Yes,what county?
❑Yes !Pao a (1)
I/We certify under penalty of perjury that the above and foregoing information is true and correct.izet- GIBBON COUNTY AUDITOR
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Address of applicant (number and street,cif ,state,and ZIP ode)
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County uditor Date(month,day,year)
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