Age_Vore� APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
` �' Sdte Fortn 43708 (R9/ 9-08)
Preun6eC by Ihe Departmerit of Local Govemmem FinarKe
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IMotmation conteined in this Cocvment is CONFIDENTIAL pursuant ta IC 6-1.1-12-9 and IC 61.b35-9.
INSTRUC710NS:
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TobefiletllnpersmorbymailwithfheCountyAudrtao/thecountywheretheproperty_islocated. GIBSONCOUNTYAUDITOR
tili�g Dafes: 7) Real Property: Durirg the fweNe (12) mmths be(rne Decembe� 31 0/ the year the tleductlon is to be eflective.
2J Mobde Homes essessetl uMer IC 61.7-7 or manulac7ured homes rat assessed as real property: Dunng the hveNa (12) monfhs
before Marti� 37 0/ fhe year the detluction is to be et/ective.
See �everse side /ar adtlltional lnsWUions aM qualiflcetions.
TyGa d berrefit reauested Id se Meck ell Nal ePNYI
�er 65 Deduction 6om Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name d epd�M�(� a���« DvyoQ
l/ V `��
ts aooiKam ure eae iegei or aa�� o,,,en If No, what iahiSRiar exaC share or inta�est? tl owned wiih someone Wher than spouse.
indimta with whom
❑ Yes ❑ No
H nama on recok u CilfereM Nan Mat d eDD�x'ant ��dirate beb«
tJame a mrtree sener (appkan( must naw baon buy'u�p on c«,rraa ef aeu o�ro (7) yeap
Mdiesa W contratl seAar (numbai aM streef, city, sdb. and Z/P mde) Is the o�oerty in ouesian:
� Real property Mobile home (IC 6-14-n
ra=�ng e�zma Key number I Legal descnotion Record num6er Page number
D�.e�,-G a!o-l3 - 19.�p� . oo/ / .00 %
Lq ihe Wo�eM used anE oauped nly br Assessed value of �he poperty as of March 1, artant yaar (may not erceetl5181,d30
his/ner'esidenm7 !or O�er 65 dedud'an, a S 160.000 !or Na Over 65 Ciicuit &eaNer Credi�
Yes ❑ No
Waa the eppficaM 65 years ot aee a mora on DecemCer 3� W i�e year
Mave you fileC tor e.ry other deducCOns9 �f �es, what daductions?
Yes � No �s .
Have you filed tw deductions in any olher murrty7 If l§s, what coumy?
� Y05 �NO
IIWe certiTy under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20
Sipnature ol a00fram PGErase of ePPlimnt (nvnb�end strooC ciry. stafe. aM ZIP code)
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ipnetureWeuNwizedraD�eseMaWe AEdrassateulhwizedraprasentative (num0era�sbeet,ciry.5tafo.anELP e)