Age_Marsh g% "i APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
d�. PROPERTY TAX BENEFITS
7.4 \
ai ,
\` s' State Form 43708(R16/1-23) ,�� ���
\!• � 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(Pleas the 11 that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of App cat owner or con ct uy Telephone Number _�J Ema Address
in 1 ` ,l' , cBk- ) 66 �
Is Applicant the uitable 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 ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is e P operty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Ke Number/Legal Description Record Number Page Number
0243 . 2c= t2 — oG-2o3-0os- 839 -0 .
Does Applicant e ' 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 ❑ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 5ear of Age or More on Decemb 31 f the Year Prior
$
Have You Filed for Any Other Deductions? If Yes W at Deductions?
es El No •
S
Have You Filed for D cti in Any Other Co ty? If Yes, hat County?
❑Yes o
I/We certify under penalty of perjury th t the ove and foregoing information is true and correct.
Sigpyrelof Ap licant Date(month,day,year)
z\\/ I ' �/1�°+6P., °l1 9/1�(?3
Address of Applicant(nu r-r and tr_et,city, (e,and i,,,,,;,e, ^�— ' •�` .
306 SW• l `a1 „. u b
Signature of Authorized Represent Ite Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of Cou Auditor 1:41 IL E ( onth, ay,year)_3•
SEP 14 2023
DISTRIBUTION: Original—CountyAuditor; File-Starred Co —Tax a ez �iur �'c
9 File-Stamped
p y GIBSON COUNTY AUDITOR