Age_Pyle (4) _-� FILE '1
:S
_a 4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
.
. PROPERTY TAX BENEFITS APR aill
es �-,4 State Form 43708(R9/9-08)
an. Prescribed by the Department of Local Government Finance
• i
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
GIBSON COUNTY AUDITOR
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
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 check a that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of appr nt(owner Or contract boye
441 /'
l
Is applicant the sole legal or equitable r? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than that of appicant,indicate below
Name of contract seller(apprmant must have been buying on contract at least one(1)year,
Address of contrail seller(number and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxuhg Key number/Legal description Record number Page number
/e 6th A ///i-ato-co//1:5-,aler
Is the property used and occupied primarily for
❑ Yes ❑ No
IfWe 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 .
Signature—of applicant
�l/ dress of applicant (number and street,city state,and ZIP code)
Signature of authorized represent a C 'fie r Address of authorized representative (number and street,city,state,and ZIP code)