Age_McCarthy 5,1,—;*•4, APPLICATION FOR SENIOR CITIZEN
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��sT. PROPERTY TAX BENEFITS couNrY TOWNSHIP YEAR
Ij. State Form 43708(R15/1-20) ��y.3t.(�1�.
t .+ /els%' Prescribed by the Department of Local Government Finance
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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
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Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the st�legal or equitable oviner? If No,what is his/here ct are or interest? If owned with hint tenant or tenant in common,indicate with whom.
Ls ❑No
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?
es ❑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? ,,��VreS ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Weal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
C� --Q,a f,d a l.Q_ - t Lk - ��I 'A - c. LiO- 001
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
No [counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real frs 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
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Have you filed for deductions in any other county? If Yes,what county?
❑Yes ❑No
I cerj' under penalty of per'ury tha e above and foregoing information is true and correct.
gnature/applicant Date(month,day,year)
Address of applicant (nu ber and street,city, tate,and ZIP code)
3l o . Cam•1 k c v- S4 . a !�c� e( Cr-\ J-Q, —
Signature o authorized repre entative ) VTte(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor� (� Datel (month,day,year)
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IrFtED
JUN 16 2023 .
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GIBSON COUNTY AUDITOR