Age_Snapp '-'-'-':a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS F
State Form 43708(R16/1-23)
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'`! =� Prescribed by the Department of Local Government Fria.ce j 5On -
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)
" Over 65 Deduction from Assessed Valuation V
65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer) Telephone Number Email Address
/'lic6el f 30 c t_e_ Snoop ()6Q ) Co 77
Is Applicant the Sole 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
✓fes No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
.7_;<:es 7 No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? —°'YQS E No
Address of Contract Seller(number and street.city.state.and ZIP code) Is the Property in Question:
al Property Mobile Home(IC 6-1.1-7)
Taxing District Key Number I Legal Description Record Number Page Number
04e2g6,_ T,,wA.Sh;e - 11-3s -30d-cot coo-DQ-7
Does Appl,can . esdde Property? Assessed value of the property as of current year assessment date(May not exceed S240,000 for Over 65 Deduction or
S199.999[counting just the homestead site(for the Over 65 Circuit Breaker Credit received before January 1.2020 and S199.999(al
es _- 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 6 ar of Age or More on December 31 of of the Year Prior
Yes do F�
Have You Filed for duction in Any Other County? If Yes, hat County? Y).24 /-el& a ura/-
GIBSON COUNTY AUDITOR
❑Yes Flo
IANe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature f Appl ant Date(month day,year)
Address of Applicant(nu ber and street,city.state.and ZIP code,l
16Il9 J c( ___r
t2)31 W 'ioo S rr;nC&I-or, A/ y >G 70 y��J2o 2y
Signatur Authorized Representative !Date( onth y.year)
Addre uthorized Representatives( urr er and street.city,state.and ZIP code)
Signature of County Auditor I Date(month. day.year)
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer \,....,ty)1