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� APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
, � Sta� Form 43708 (RB / 9-08)
� P'asuibed Fry the DepaMmanl of Local Govemmem Finance
I�ormation oontainetl in Nis tlowmenl is CONFIDENTIAL pursuanl to IC G7 J-12-9 and IC 6-1.1-35-9.
�
INSTRUCTIONS:
To be filed In person or by meil with Ure CourrtyAUdita ol fhe oounty where the properfy is located. M�QY 2 8 2 �O9
Filing Oetes: 1) Reel Property: Durirg fhe hveNe (12) marths belore December 31 0/ fhe year fhe deductlon is to be efleclive.
2J Mobile Homes assessed urMer IC 6-7. 7-7 orinanulacturetl homes nof essessed as real pioperty.�p,/u/n�rn� Ne N/lreNe (72J monfhs
before March 37 0l the yoer Ne deduction is fo be eflective. �"� � N�
See reverse sitle lor atlOiGOnal insLVdions erM qualifications. GIBSON COUNT Y A UDITOR
TyPa d be'reN reauesteE (Nease theck e9 Mat app�
�Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
(/�
H name on recortl is diflararit ttwn that of aDD�cent indifate 6eb«
seller (epplicanf musf fuve boon buyi�7 m cmtracf af loast orre (i) yea�
Addresa o1 mntratl ae�er (number entl sbaef.
aM ZIP mtle)
Key number I Legal descnption
"�`f-d5-10
4a the wovenr �sea e�e ocwaea w�++any fo�
hiaher rasidenfs7
�Yes ❑ No
Was Ihe eppGtaM 65 years of ege or mwe on Decemb 7 d lhe year
DtlOf t0 thB Wrtettl y02/1
Yes ❑ Na
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not exceed 525, 000; for the Over 65 Circuit Bieaker Credit,
incane may rrof exceed 530,000 for individuals, or 540,000 for
manied couples).
Have yau filed tor erry 01her
❑ Yes
Have you (ded fw deductions in eny dher cwMy7
❑
euthorizad reGrasentative (numberarN strool, ciry, stafo, and LP code)