HomeMy WebLinkAboutAge_Parke `-�="6.. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R16/1-23
!O'•% 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. \
1 Type of Benefit Requested(Please check all that apply) `.
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
'Yes - No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
ert
y'
L . �es No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract r at Least
One(1)Year before Claiming Deduction? ?Yes Jo
Address of Contract Seller(number and street.city.state and ZIP code) Is the Property in Question:
oOOO. 65O- /
26 r Iy 0 7'go
o- C�(p 'y` Real Property Li Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
ColumbiFt PT W SE 7 X 8 2,1,35X. C.- I
Does Applicant Reside 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. 2020,and 5199,999[al
Y 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 65 Year of Age or More on December 3131 of the Year Prior
-y Q r� �1— Z
Lb Yes ❑No I /10/ne 1GAt� I t'operJ !/t� s=C /cJy�iy/ ��¢���u 7j
tra
Have You F:led for Deduction in Any Other County? If Yes,What County' 1
El Yes VNo I
I/We certify under penalty of perjury that the above and foregoing information is true and correct. '
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Signature of Applicant Date(month,day.year)
4 P G f/VIY1---- ,r y- 2i — 2.F FAddress of Applicant(number and street, city.state,and ZIP code) IL
I
Sianaf-i.a of Authorized Representative 1 Date(month. day.year) 4
1
Address of Authorized Representative(number and street,city,state.and ZiP code) ‘)2'wL- ,am di '2..V.
GIBSON COUNTY AUDITOR
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Signature of County.Auditor I Date(month.day.year)
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u 'eecr_ Owe nD 1\.2, �cAe . — c 1 �a
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer e