Age_Trible as APPLICATION FOR SENIOR CITIZEN ta@ �; YEAR
!.-. - PROPERTY TAX BENEFITS
State Form 43708(R9/9-08)
S uu i Prescribed by the Department of Local Government Finance t
Iea
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: 4
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 Properly: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 beneft requesrtted�(p/lease Mack aD that apply)
IXI Over 65 Deduction from Assessed Valuation labver 65 Circuit Breaker Credit •
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitable owner? 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 applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(I)year)
Address of contract seller(number and shoet,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
Pz6 -a3-et'-doe-000. 79aoo 9
Is the property used and occupied primarily for Assessed value of the property a of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,of$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 tiled for any other deductions? If Yes,what deductions?
2-yes In No 1-4
Have you fled for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
IIWe 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 eddress of applicant (number and street,city,state,'and/ZIP code)
f.��f-f 2 jib l-C� 2 3 �3 a2.cr-e- C 4-G---2-4,cii--. .- f/76,3,
Signature of authorized representative Address of authorized representative (number and street,city,slate,and ZIP code)