Age_Richardson � '� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
\ 1 ,
ii ,�Y.�4 PROPERTY TAX BENEFITS
State Form 43708(R16/1-23) Cj r�r7pN W a-%V\- 5 03
'�•/ 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.
Ty Benefit Requested(Please check all that apply)
L�'Over 65 Deduction from Assessed Valuation L er 65 Circuit Breaker Credit
me of A plicant(owner or contract buyer)
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?
Q-efes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? [ -T ❑ No
Address of Contract Seller(number and street,city,state,and p.eode) Is the Property in Question:
dReal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Numb r/L al Description Record Number Page Number
WGSV, ovv 9G-o -a a-3co-tom . Ltaa- o Il
Does Applicant Reside on Property? Assesse al e of the property as of current year asse d to(May not exceed$240,000 for Over 65 Deduction or
$199,999(coun'ng just the homestead site)for the Ov 5 Circuit Bre er Credit received before January 1,2020,and$199,999(al
❑ Yes ❑ No Indiana real property]for the Over 65 Circuit B er redit initially appli for after December 31,2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December 31 of the Year Prior
[ales ❑No k-kVMe 5 tact( .1 � `\ k...
Have You Filed for Deduction in Any Other County? If Yes,What County?
ElLr�Yes lvo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
EZI lure of Appii nt ^ Date(month,day,ye
Mlii IF I 3/ /5/ -J*19 2_Afiric-. 1),s 5
'Kress of Applicant(number and street,city,state,and ZIP code)
97a5 e '1Q tJ F-\e "LA/ '( 7 G 4
Signatu of Authorized nrfnt five r Date(mo ,day, ear)
Fl /.5 -7 3
Ad ss of orized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
.- � - FILED .,,v ,6,2,
AUG 1 5 2023
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DISTRIBUTION: Original-County Auditor; Film ed oqy,-Tqic64 payer
GIBSON COUNTY AUDITOR