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Age_Vaughn 17-r--'at APPLICATION FOR SENIOR CITIZEN - COUNTY I TOWNSHIP YEAR f PROPERTY TAX BENEFITS � S`. - m 43708(R'. -_, C G I bson I 0 ( Prescribed by the Department of Local Government Fnance 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:1 Benefit Requested(Please check a', at apply) __ — Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit .im - a^.Apo!c rcry --c-^rac!b'yen, If Owned with Joint Tenant cr Tenant's Common.Indicate with Whom , •ryes _ No 1 If Name on Record is D ffe-ent than Applicant.Indicate Below. Do All Joint Tenants or Tenants in Common Reside on the Property? ' I Yes 72 No Name of Contract Selle Has Applicant Owned or Bought the Property Under Recorded Contract for at Least ' I One 0 j Year before Claiming Deduction? ' Y8S _ No Address or Contract Setter(number and street city.state and ZIP code' Is the Property in Question j -.Real Property _ Mobile Home(IC 6-1.1-7) Taxing D strict ` j Key Number,'Legal Description Record Number Page Number ©a� ( Gk-t, a6-IY-($— Vo3-coo. 67 9- 00-7 Does Appl cant Rend on 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 1.202G.and S199.999[ai _ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31, 2019.)See reverse for details. Is the Appl cart 65 Year of Age or More on December 31 of the Year Prior Yes ❑No j Have You Fled for Deduction in Any Other County? If Yes.What County? - - El yes al I/We certify under penalty of p, -txy that the above = . oregoing information is true and correct. T arj' Address of Appl can?(number and street. cfy state.and ZIP code) 09 ID7 5 East- 54- 00, G z,N inGGo Signature of Authorzed Representative 'Date(month. day.year)F i1_1ED _'_ Address of Authorized Representative(number and street.city.state and ZIP code; S g^azure •C°_^,YV G V y year)Date!month. day 0/may/may -- ( ad) GIBSON COUNTY AUDITOR DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer