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4: APPLICATION FOR SENIOR CITIZEN co tall!ow ; • • .k,rEAr� '
.;'_. PROPERTY TAX BENEFITS 1 f
•y - . State Form 43708(R9/9-08) Local me er Prescribed by the Department of Lo Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
lievINSTRUCTIONS: iiikar-
To be filed in person or by mail with the County Auditor of the county where the property is located. GIBSON COUNTY AUDITOR
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested ase deck all that apply)
ver 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(ormel or contract buyer)
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Is applicant the sole legal or equdable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
Nes 0 N
If name on record is different thdn that of applicant indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Co ktinbia_TWIr`1/o a(D i3- IS - .bb-°co. -3)-0-2-ciatc°
Is the property used and occupied primarily for Assessed value of the properly as of March 1,current year(may not exceed$182,430
higher residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
Yes ❑ No
Have you Ned for deductions in any other county? ,,,,,,������pppp d Yes,what county?
❑ Yes ErNo
I/We certify 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 1,20 .
Sign of applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of prized rep entative Address of authorized representative (number and street,city,state,and ZIP cod )
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