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Age_Lloyd ��"=� APPLICATION FOR SENIOR CITIZEN . ,`�,�� COUNTY TOWNSHIP YEAR Iir . PROPERTY TAX BENEFITS '�J -1 State Form 43708(R16/1-23) �; Pr't h .`"1, 3�• Prescribed by the Department of Local Government Finance �� 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) 57-Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit Name of Applicant(owner or contr ct buyer) Telephone Number ' ''sal.,_, c %oA Email Address (Art 1--�10�(0l0. y,� 8l ) 1�35-CQUa9 Is Applicant the Sole egel•-dr Equitable O r. If No,What is His/Her Exact Share or Interest. If Owned with Joint Tenant or Tenant in Common,In 'ca e with Whom --c hfie-(' es ❑ No S�yA�.�{ 1 'I V t' .p,(C If Name on Record is Different than Applicant,Indicate Below Do All 4zi9Nenants or Tenaftlein Common Pr operty? on the Pr perty? CienR ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least Pr One(1)Year before Claiming Deduction? t!YYes ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property/�' in Question: L(d'Rea 1`S c P l Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number P 1 • lfl.- Ia-O%_ 3n( -- ©oI. -0 . Does Applicant Resid on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or $199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al Yes ❑ No Indiana real property]for $ Have You Filed for Any Other Deductions? If Yes,What Deductions? a Yes ❑No - &0-4-YNe.- e--QO1 Have You Filed for Deduction in Any Other County? If Yes,What County? ❑Yes Eii.fQo I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Date(month,day,year) • Address of Applicant number afid trf{ ed,city,state,and ZIP code) i-• P.),,,,,_- ,__J-04,, ,DI, - \--vt. L-J2-7 0 Signature of Authorized Rep .111k, \� Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) T Signature of County( Auditor o (�,\ .Q� ( 7 Date�lnnthTda year D ( N_'4 �eL_SL _ • �0 i \A,X A P^r'�i�`-'�/ . 1T� 1 1 .- ,f J c::IA(l/ J U L 21 202 ` - ;� . �iNg(\\ . DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer GIBBON COUNTY AUDITOR