Age_Williams (2) t,•• '-'-jai APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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;�t ' PROPERTY TAX BENEFITS
3NtiW,/ State Form 43708(R 16/1-23) I ,,^./, ID`� �ZU
t''— Prescribed by the Department of Local Government Finance �J `
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 '
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant(owner or contr ct b' er)
Owned with Joint Tenant or Tenant in Common.Indicate with Whom
_YYes _ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
_ Yes 77 No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? E
es _ No
Address of Contract Seller(number and street,city.state.and ZIP code) s the operty in Ques n:
Real Property Mobile Home(IC 6-1.1-7)
Taxing District Key Number i Legal Description Record Number Page Number
C0-29 • 2-L'"04 2Y--101 -000 fl 7 020 .
Does Applicant Res e on 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 Appllca 65 ar of Age or More on December 31 of the Year Prior
lotions?
I♦ es ❑No -Have You Filed for!. • -uct.n in Any Other Count ? If Yes,W County? IF
IL T•IEL
I11Ne certify under penalty of perjury t at the above and foregoing information is true and correct. AP 7 24
Signature of Applicant Date(month. day.year)
ci
` Add er ss O`Appj (number And street,city.stZrnd Z code) 22L/ aaund)
ed
3DG r )� l
)A fj S� GIBSON COUNTY AUDITOR
Signature of Authorized Representative ) , Date(month, day.year)
Address of Authorized Representative(number and street,city,state.and ZIP code)
Signature of County Aug Date( onth. y.year)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer