Age_Turner , R4}�4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a/ ..\' PROPERTY TAX BENEFITS -
X4.0.if State Form 43708(R15 I 1-20) �`pp
+���' Prescribed by the Department of Local Government Finance D,(17..�V t, P n zo Z�rem �J
t
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.)
I_`I'Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Na a of applicant(ow r
If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the property?
[ii.YLes. ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before cl iming deduction?
❑Yes ❑No
Address of con rf act seller(number and street,city,state,and ZIP code) I h roperty in question:
eal property ❑Mobile home(IC 6-1-1-7)
Ta g district - Key number/Legal description Record number Page number
tr rn r1ce_k-car a lQ-\ i- 19-100- M2,.Q c}S- o -De
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
eS ❑No (counting just the
? II
s ❑No � 140341 — �-ee ylfllln
Have you filed for deductions in any other coounty?t If Yes,what count ( 1
❑Yes LH'f�10 \( r ���..JJ ,Q c (Lec) ..
I/We certify under penalty of perjury that the above and foregoing information is true and correct. Y `, T
Sig of a pli .nt_ • �-; /J�� Date( ...th,d year) .
k24-.. 614---4-41- C ..)1..4.-.4. ....32-,•-•
Address of applica t (number and street,city,state,and code)
0 0 . Yra.� - f. ..)•.t.'( - C u 1 LIZ o
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). \c,30,J- kb.:„. ) s._i_D ,
cipELED _
MAY 0-9 2023,p `
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GIBSON COUNTY AUDITOR