Age_Creedon"' a APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
StatB Fam 43708 (R9 / 9-OB)
•� ! PrescnbaE by ihe DepaMmeM of Local Govammam Finanw
IMormatiom m�tained in this tloa�ment is CONFIDENTIAI pursuant lo IC G7.1-12-9 and IC 6-1.1-359.
INSTRUC710N5:
COUNTY TOWNSHIP YEAR
Rle Mark
To be ned in person or by mail with the CouMyAUtl'rfor ol (he wunty where the property is laca(etl. ���� 3J
Filing Dates: 1) Real Property: Dunng Ihe lweNe (72) months be/ore Decembar 37 0/ the year the deduction is fo be effectnap.'
2) Mo6rle Homes assessed urMe� IC 61.1-7 or manWactured homes rwt assessed as real property.� D��Vh�weNO (f� mmths
M1n(iwn E.fa.M 31 n/fhw vwnr Ihw dwrlucfinn Lc tn hw wflwNvw
See reverse side lor adtlaional insWCtlons arN qualificatlms C-��
Type d benefl requasted (please rhack a0lhaf apply)
GIBSON COUNTY AUDITOR
�.Over 65 Deduciion from Assessed Valuation Over 65 Circuit Breaker Credit
Name o( appGrarit (owner or contraG bvye�
�m �
Is app6an e sde lepal or equilabi neR I( No, t is his/her exacl shara m iMerest7 H o-xnetl Hilh mmeone other Ihan spouse,
�iMi�atevnfhwhom .
es ❑ No
H �ama on recad is diRerenl than thai af apd�nt, indiceta bebw �
Name of �nntract se0er (appl"manf mvst hare been buyirg an confracf at lea5 one (7J yearJ
7 1 �
Address d contran mAer (number aM sbeeL �N, sble. eM LP mde) Is ihe proparry in auestim:
�Real pmperty � Mobile home (IC Sf-i-�
Tazirre Aistrid Key numbar / Legal desuipl'an Record numbar Page number
-3�- a0D-GLb•3 BF-Od
Is the popaM used aM ocwpiad pri rily for Assessed value of lhe property as ot March 7, cyrrent yaar (may rpf e+rsea SiB2,130
hisTher residence7 firO�er 65 deduCim, u-Sf60,000lor Ne Over 65 C'vcu"rl &eaker CrediQ
� Yes ❑ No
Was Na aOP�M 65 years of age or mora on December 31 d ihe year
Have you filad tor a'ry other tledudions9 If Vus, what deducCOns4
� Yes � No
Hava yw filatl for deductions in any Whar counry7 If Yes, what muMy?
� Yes No
IIWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a residenl
of Indiana and owner of the aforemenlioned property on March 1, 20
Signature of applilsnt Pddress ot applimnt (num0orantl straet, city, stafe, aM ZIP e)
35 ' �
Sig u�e d authortz e Addrass of aulhw�d repeesentative (nvnEOraitl strce4 �: state. anE LP mCe)