Age_Mattox <"" APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7 I Il. PROPERTY TAX BENEFITS
.0 ), State Form 43708(R16/1-23) q ,SQ n 0-j8 f.023.
'�'• Prescribed by the Department of Local Government Finance J
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/oc ee 1 T
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmaRred JJ ,1J
January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. J U L 2 1 2023
Type of Benefit Requested(Please check that apply) eAUD-ITOR
Over 65 Deduction from Assessed Valuation Over 65 Ci .;ll<-� a vf.
Name of Applicant(o er or contra t b er)
? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
-s ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? E Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t e roperty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
0 ?3 26-t2-06-\'t03-ook 3.°-' 2-
Dces Applica eon 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
es El No Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applica:Kd
ear of Age or More on December 3 of the Year Prior
Yes El No
Have You Filed for d tion in Any Other C un ? If Yes, hat County?
❑Yes No
I/We certify under penalty Aof perjury at t above and foregoing information is true and correct.
Signs re of Applicant Date(m nth, y,year)
----8 ............,...c .4) 4trar;-_,
•
Addres of Applicant(number and street,city,state,and ZIP code)
L.t28 r �er \'o.,'- ,Df-tiro
Signature of Authdcited Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor C
FILED Date(mon h,day year)
�'111� i ns 21 3 .
JUL 21 2023
i
DISTRIBUTION: Original—County Auditor; File-Stamped CiiV92z.jkcietl .�t,Y.,Lrt(i)
GIBSON COUNTY AUDITOR