Age_Brittingham�
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"'" APPLICATION FOR SENIOR CITIZEN
:�-. - : PROPERTYTAX BENEFITS
S--' Stala Form 43708 (R9 / 408)
Prescnbed by Ihe Dapartmem of Lasl GovemmaM Finance
NTY T N IP - CtiAR
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�"'Fle Mark
Informatiom m�iained in lhis documenl i5 CONFIDENTIAL pursuanl lo IC 61.1-12-9 antl IC 61.135-9.
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INSTRUCTIONS:
To6efiledinpersonorbymailwith(heCountyAuditorolthemunrywherethepropertyislacated. GIBSONCOUNTYAUDITOR
Filiry Dates: 1) Real Property: Dunng the AveNe (72) marths 6e/ore Decem6er 31 0/ the year fhe tleduction is to 6e eRecfive.
2) Mo6ile Homes assessed urMer IC 67.1-7 ormanulactured homes rrof assessed as rea/ properly: Dunig the twaNe (12J monfhs
6e/ore Marrh 37 of the year the deduction is fo be et/ecWe.
See raverse sitle for addAional insWdions arM qualifications
Type d banefit �equesleC (p/oase rheck a0 fhaf apply)
r 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit
Nama d appGcant (ow�mJ cmtract Duye� .
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Is applimn a lagal o� equitaWe ovmeR If No, what i's/her ezaa shara or irnerast? tl ed with someone olher lhan spoum,
i d' te vriN whom
❑ Yes ❑ No
I( �wna on �d ia dMeram Ihan Ihal of applimnL i�Mkate bebw
Nzme m mtl2a sener /aaW,u,�� m�� nare eeen nuyN9 ai conhacf af x,ast orio (7) rearJ
AdCrass d mntrad wller (nwnber aM streef, city, sfale, ard LP wde) is me v�vaM � a�astio�:
e I pmperty ❑ Mobile home (IC &74-�
Taai(q dislrict Key number / Lepal tlescnption Record numbar Page number
- Z/- 0 600 0 O-
I� Ihe pmpaM �� and ied primarJy for AsseaaE value of ihe propeM az of Ma`rh t, curtant year (may nof esraetl SiB2.430
hisiher residenw4 lwOrer 65 deduriion, or 5760.000lor Ihe O�er 65 Cuctit Brealmr CreEiQ
Yes ❑ No
Was the appfrvm 65 years ot age or rrore on OecemCer 31 of ihe year
Have yau filetl fw arry other deduttions7 Ii 14s, wtut deductioris?
s � No
Hava yw �i ed fu deductiorvv in any mher munry? �f Yea, what munry?
� Yes � No
I/We certify under penalty of perjury thal the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Sign d a Address of ap0�m (mun0or a�b stree4 ory. sbta. aM ZIP wda)
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Si re d- wized re0�an aVV � Address af aulhorizetl representalive (numDOr ami stioot, dty, sfata, and LP cao'e)
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