Age_Chapman �V•_• APPLICATION FOR SENIOR CITIZEN
+�� COUNTY TOWNSHIP YEAR
674 •� PROPERTY TAX BENEFITS
x'a' t'+ State Form 43708(R15/1-20) ` W�,t e-
�3`� Prescribed bie lay the Department of Local Government Finance lit Son �;v e
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.
IIIIIIIIF7/
Over 65 Deduction from Assessed Valuation 2 Over 65 Circuit Breaker Credit
' Name of applicant(owner or contract buyer)
MafCO- 14 C�R n 1\10(Is applicant the sole legal o5ultable ov}ner? If No,wha/ iee isiher exact share or intrest? If owned with joint tenant or tenant in common,indicate with whom.
1`iYes El 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?
[r (es [II 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? des ❑No
Address of contract seller(number and street,city,state,and ZIP code) Isr the
�property in question:
Ls Keal property E Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
WhNace 1J te.r g,6— bI a3-- 700-crx7. MO - O l8
Does applicant reside on ope . Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or5199,999
❑No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
es 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?
❑Yes [1v10
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
—g at - o[ t_zp licanl ',,ii 1 Date month (:
Address of applicant (number and street,city,state,and ZIP code)
3(0dN G-'FO 6.- a.I jV Y 7 6C (0,
Signature of authori representative 94aSi')- " Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
AL(‘--9- .?--v IL 4IY'
, _ ;\\ ,ci,, 0311/43 . . NcopA;3 •
JUL 11 2023
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t- -____.- — b900 0--74A-- C_ (4,00 -1 , ,zaui_,j a.,.,d-- 7,4)
GIBBON COUNTY AUDITOR