Age_Logsdon e APPLICATION FOR SENIOR CITIZEN `L3:a'; 'j':�E L^1'iE'Imo' ? YEAR
PROPERTY TAX BENEFITS 1 1
State Fonn 43708(R9/9-08)
raw Prescribed by the Department of Local 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.
INSTRUCTIONS: xlitte
To be riled 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 fwewe(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-I.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 bene£t requested(please check aft that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
/JaAA5L1 n
Is applicant the sole legal or equitable owner? If No, is his/her exact sham or interest? If awned with someone other than spouse.
indicate with whom
❑ Yes ❑ No
It name on record is different than that of applicant,indicate below
Name of mitrad seller(applicant 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 propel rly in question:
Real property ❑ Mobile home(IC 6-I-1-7)
Taxing trict Key number/Legal description Record number Page number
3oo -0D1. 2Oy -OA 7
Is the property used and occupied pdmanly for Assessed value of the properly as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
g'Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you fled for any other deductions? If Yes,what deductions?
aces f lNo Jj 5
Have you filed for deductions in any other county? lf Yes,what county?
❑ Yes No
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
Signature at applicant Address of applicant (number and street,city,state,and ZIP code)
k tArli 7' grifIeI i-c) '401 AL aa5 t✓. IA! g7CpgO
Signature of authoriz reprasenta Address of authorized representative (number and street,city,state,and ZIP code)