HomeMy WebLinkAboutAge_Wint •=7:-- ' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
'
, `� PROPERTY TAX BENEFITS
: State Form 43708(R16/1-23) O(''1 l •o 23
Zr• Prescribed by the Department of Local Government Finance lJ •
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(Pleas chec all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ph ant(owner or co tr uyer) Telephone Number r E ail Address
De - n-)-- • (3I2-) 11b -9 0 14- .
Is Applic nt a or Equitable Owner? If No.What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Yes ❑ 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? ❑ Yes E No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t e P perty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
DOLLZ613- 19-m2--00o.-7-5S -0o4 .
Does Applicant Re ' e 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 E No Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applican 65 ear of Age or More on December 3 of the Year Prior
$
Have You Filed for An Ot r Deductions? If Yes,Wha Deduction
❑ s?�t�
Yes No X j 'J•S c "I)
Have You Filed for D duct n in Any Other Count ? If Y Wh t County?
❑yes No
I/We certify under penalty of perjury that t e above and foregoing information is true and correct.
Signature Applicant ( Date(month,day,year)
•41. —. 7.,/.4.."- g/3/2.0 2-5,_
Address of plicant(number and street,city,stat and ZIP code) ,, t
g E l�� -S • IN) ' - . .
Signature of Authorized Representative / C 1-3-ate(monk(day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County itor Date(month, y, ar)
i)t) \1 r)J T 2 70z2
FILED
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AUG 0 3 2023
DISTRIBUTION: Original—County Auditor; File-Stamped Copyftw (2, Jtavnd)
GIBSON COUNTY AUDITOR