Age_Hunt , - APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
.'� >1 PROPERTY TAX BENEFITS } 2.723
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State Form 43708(R16/1-23) S Cjv O 2�
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(Please check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name ofApplicant(owner or contr t b er)
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 the roperty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description • Record Number Page Number
OZTh- 26-11-A-too - L{ -, 89'- 02i- -
Dces Applicant Re ' eon 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 ear of Age or More on December 31 of Year Prior
filed a joint return with the individuals spouse.)See reverse for details. TOTAL $
Have You Filed for Any Oth: Deductions? Ii./s,What Deductions? F IL 1_,,, r 1!' Yes ❑No �L//U . 1 J
Have You Filed for D •uc i. in Any Other County? If Yes,What County?
El yes [(No DEC 0 7 7[123 C...)\
f UWe certify under penalty of perjury that/ theth above and foregoing information is true andcorrect. �9
XSig re of Appli '�•�L�Z-� C.C:, der .Ye
( �� GIBSON COUNTY gUDI 2
Address of Appli nt(number and street,city,state,and ZIP code)
2.057- t.A3 c 1fit n— ,5 r\1 - L-k -6�D
Signature of Authonzed Representative Date(month,day,year)
Address of Authonzed Representative(number and street,city,state,and ZIP
code)�ode
Signature of County Auditor_ \n \�`-�\ �� / ` Date(moot day, ear)
V ` I ,,I/l/L�/,�,Ili\I S �� ' V2 ‘023 .
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
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