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Age_Cochrane ra APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 7 ``. PROPERTY TAX BENEFITS a\."r4`' '(i* State Form 43708(R16/1-23) a,; �"°='� iIivs0 NI DIKE➢ o 4- a• Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. J 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) Over 65 Deduction from Assessed Valuation .Over 65 Circuit Breaker Credit ame of Applicant(owner or nfracf buyer) Email Address 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 Yes ❑ No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? )J,Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Claiming Deduction? ❑ Yes 'Jo Address of Contract Seller(number and street,city,stale,and ZIP code) Is the Property in Question: Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key '^1 j Key Number//LJeg I Description (� (��) /'�/'� �//� '//J Record Number Page Number g✓ ara DDI 62(c ~r4— Vr3o-T -DL''V rgq`DD 1 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 LZYes ❑ No Indiana real property]for the $ Have You Filed for Any Other Deductions? If Yes,W t Deductions? f 1� Yes El � &—Ser�� b Have You Filed for Deduction in Any Other County? If Yes,What County? ❑Yes gNo INVe certify under penalty of perjury that the above and foregoing information is true and correct. ' lure Applicantr� Date(month,day year) .0 SC\� /0C)/ C/ Address o pplicant numbe79pq street,city,state,and ZIP co^_r_ 04..ktizt tjci) e.../77/ /xi 4-742426 Signature of Authorized RepresentativeDate(month,day,year) 9 Address of Authorized Representative(number and street,city,state,and ZIP code) Signatur o County uditor 1 Date(month, ay,year) a.tLnriet;ii(.. /iitio 6 ,g() Q747 FILED U DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer OCT 3 2024 �/ �CI cktd a.1/Y.z�,&Id GIBSON COUNTY AUDITOR