Age_Kiesel f
FILED
SEP 2 5 2023 ii7/
PP TI FORSENIORli r Pi
APPLICATION CITIZEN GIBSON COUNTY AUDITOR COUNTY TOWNSHIP YEAR.4'7
1 PROPERTY TAX BENEFITS
'�/`I State Form 43708(R15 i 1-20) / 03
�' / Prescribed by the Department of Local Goverment Finance V,15 c, \n,0,
File Mark
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.) i
{ liver 65 Deduction from Assessed Valuation E over 65 Circuit Breaker Credit
Named (owner or posited dryer) -/
Da v > Z i 1 P.
. 1S ej 1 zi '-s q 1(l e-s
appbcarf the sole legal or niWble owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Xik Yes ❑No
apt
If name on record isdt►ere nt than that ofindicate below. Do all joint tenants or tenants in common reside on the property?
❑'�t:s ❑No
Name of contract seller Has appbcard owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction? D 4es ❑No
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number I Legal description Record number Page number
VrkDh 24-19-30-3 oo—coo. sal— b a5
Does applicant reside on• • ? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199.999
�r Yes ❑No (counting the homestead forMe 0re'r 65 Grunt Breaker Credt received before January 1.2020 and$199,999 fat Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years'of..: . more on December net the year
Have you fled for any other ded ? If Yes,what deductions?` _ 1
Yes ❑No �.1oyv v S-ec
Have you filed for deductions in any other If Yes,what county?
❑Yes
1
1/We certify under penalty of perjury that a above and foregoing information is true and correct.
S dagpifapt , f.,e...s.p Date(month,day,
y,year)
Address
ofapplicant ( and street.city state,and ZIP code) d
4`+10 S W �kJbsb.df N 4f7 6
Sind authorized� r Date(month,day.year)
� tP
Address of authorized representative (number and street.city,state,and ZIP code)
Signature of County Auditor / Date(month,day.year)
_/ ' �„t_'ya c,t,r�- 1,1/ ?/25/a 3