Age_Belcher ,,`"""c APPLICATION FOR SENIOR CITIZEN r COUNTY TOWNSHIP YEAR
.: ' 8 PROPERTY TAX BENEFITS
, •.` ` State Form 43708(R16/1-231 r)G 150 �t f t'`(1'0� o�f
-faik - Prescribed by the Department of Luual Gciernment 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 flied 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
ZOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
i -
' Name of Applicant(owner or contract buyer)
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
s _ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Z'Yes _ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
i One(1)Year before Claiming Deduction? O Yes No
I 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
W\'.�- �:v er a6-oaf,Q-Roo-coo o Ito-pl g
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240.000 for Over 65 Deduction or j
":-.1 .
_ $199.999[counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
Yes _ No Indiana real property]for the Over 65 uit Breaker Credit initial) alilied for after December 31,2019.)See reverse for details. i
Is the Applicant 65 Year of Age or More on December 31 of the Year Prior ,,
Have You Filed for Any Other//Deductions? If Yes,What Deductions?
0 es ❑No iskd 5r-t'a..1
Have You Filed for Deduction in Any Other unty? If Yes,What County?
❑Yes
1 I/We certify under penalty of perjury that the above and foregoing information is true and correct.
_ �� �,h, ACAL&V-Ce__ O �-"1- l11-Address of Applica number and street,city. and ZIP code)
G1l$ A Old US -& ` k Nrct e.6,1 -=N y?G Ho —
gnature of: izeo Representati ay.year)
Address of Autho d Representative(numbe nd sheet.ci ,state,
F 1)
Signature of County Au 'Date(month,day.year)
L_ / AJ. - - - - 9 - 31,7/ /
MAR 2 7 ZU
y&kui and)
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer