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Age_Simpson ~+i APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR �; . = PROPERTY TAX BENEFITS x_ r' � C/� * 1 State Form 43708(R16/1-23) So oho. 'e16 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) Over 65 Deduction from Assessed Valuation N Over 65 Circuit Breaker Credit Na of Applicant(owner or ntract buyer) r If Owned with Joint Tenant or Tenant in Common,Indicate with Whom L.Yes El No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? gYes ❑ No Name of Contract Seller Has Applicant Owned or.Bought the Property Under Recorded Contract for at Least t- r' One(1)Year before Claiming Deduction? ❑ Yes X No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: )4 Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District !hfh—(© Key Number/Legal Description Record Number Page Number ea0 `7oii/ /?, _ �.a5-- . aa,moo.5--qq-0g O 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 JL1,.Yes ❑ No Indiana real property] $ Have You Filed for Any Other Deductions? If Yes,What uctions? tYes ❑No Have You Filed for Deduction in Any Other County? If Yes,What County? ❑Yes 5 No I/We certify under penally of perjury that the above and foregoing information is true and correct. Signature of Applicant Date(month,day,year) {1'Y\\��� �--_ _ _ l -3(-r�a Address of Appli ber and street, ity,��te,^and Z/IP code) / /64 Signature of Authorized Representative Date(month,day,year) Address of Authorized Representative(numberrt and street,city,state,and ZiP code) Sign to a oFCo my Auditor y1' fi / Da�(monf�,day,y r) //�J1` y//II /. 2,0a`/- 16 FILED D • DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer DEC 31 2024 � hici- z & .JAY nd) GIBSON COUNTY AUDITOR