Age_Kramer ".`•" .a• APPLICATION FOR SENIOR CITIZEN ClUNTY TOWNSHIP YEAR
4:4 4, PROPERTY TAX BENEFITS
,I iY; State Form 43708(R16/1-23) J V• \ Q Z3
�_
!•i!i 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
.
Type of Benefit Requested(Pleas ch k all that apply)
Over 65 Deduction from Assessed Valuation 1 Over 65 Circuit Breaker Credit
Name of Applicant(owner or cont buyer) Te hone Number Email Address
ii k Mt-A _ ( 1-- ks8 ,sU04 _
Is Applicant th ole Legal 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
i
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 L] No
Name of Contract Seller Has Applicant Owned or Bought the Property U r corded 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 roperty in Que ion
Real Property E Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
2G--18—51-k o 2--0 0 o, Slo--o9
Does Applica Resld- .n 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 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 Applica. r of Age or More on Decemb 31 the Year Prior
Have You Filed for An Other ductions? If Yes,W a Deductions?
es ❑No _ S
Have You Filed for De lion in Any Other Co nty? If Yes,Wh4t County?
❑Yes No
I/We certify under penalty of perjury th t th above and foregoing information is true and correct.
Signature of Appli.-,fj Date(month,day,yea
•
442/YK-e-4-
X
Ad�resos o2-plic.+ (num�J_' and 1 eele state. n \R- 48
Signature of Authorized Representative \ Thel:f4N61_0
Date(month,day,year)
Address of Authorized Representative(number an r et,city,state,and ZIP code)
Signature of Coun Audit r Date(month day
vvs-
I
OCT 0 5 2023
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
ItQLL a: 6464.4)
DITOR
GIBSON COUNTY AU