Age_Corn "s. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR '
t PROPERTY TAX BENEFITS
State Form 43708(R9/9-06)
S,-.: ---I'
Prescibed by the Department of Local Government Finance i k
0.11111 Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: MAY 8 2013
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 eff
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Du onths
before March 31 of the year the deduction is to be effective. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit rogue ed ease check al that apply)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ,, iAnt Witmer a contract
buyer) - SYZ../ .
Is applicant the sole legal or equitable owner? If No,what is Mather exact sham or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than 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:
pr;I meal property ❑ Mobile home(IC(i1-1-7)
Taxing da Key number/Legal description //"""Record number Page number-/3-//-fro-�/92-ate
s e preperty used and occupied pdmadry Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her 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
of death?
Adjusted gross income of applicant,spouse,and any
Zt Yes ❑ No gS
Have you fled for deductions in any other county? If Yes,what county? .
nYes ❑ No
INVe 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 •
Signet of applicant Address of applicant (number and street.city,state,and ZIP code)
fiC 7 d etic A /0/f a L co s dhlia,r6C 9z-. v76 6d
Signature of authorized representative Address of authorized representative (number and street.city state.and ZI e)