Age_Channell r."1` ch APPLICATION FOR SENIOR CITIZEN COUNTY T WNSHIP YEAR
PROPERTY TAX BENEFITS P -
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State Form 43708(R16/1-23) cod D �,D
'•�• 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.
Type of Benefit Requested(Please check all that apply)
"X Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Na �. �. f•r j( r i . j4aJ c�
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
%,Yes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Underper Recorded Contract for at Least
One(1)Year before Claiming Deduction? ,XYes No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Ques ion:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description �5 c Record Number Page Number
D� �D^` [�--- 400-000, SSV rD ao
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
�--, $199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
D I Yes ❑ No Indiana real property)for the
$
Have You Filed for Any Other Deductions? If Yes,Wh t Deductions? �r—�/�
. !Vu Yes ❑No e6 I',, Cl�`'f'�
Have You Filed for Deduction In Any Other County? If Yes,What County?
❑Yes dNo
I ertify under penalty of perjury that the above and foregoing information is true and correct.
X Si. . e of Applicant Date(month,day,year)
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Addres of Applica mbar and styeiat,city,state,and ZIP o e)
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Sign ur oWounty Auditor /� Date(month, y,year a /
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FIL 1;I�
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer A U G 0 9 2024 ,3 'b
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GIBSON COUNTY AUDITOR