Age_Thompson x:.-A APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR '
-:2."'',1 PROPERTY TAX BENEFITS
:.e; ;- State Form 43708(R9/9-08)
6ui.-r Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
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 tq p�'e(�c�ve)014
2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real props unng fTie`twelve(12)months
before nal instructions ru 31 of the year the deduction is to be effective.
firtuwacceiEr
See reverse side for additional insWCfions and qualifications.
Type of benefit requested(plea check all that apply) GIBBON t.UUNIY AUDITOR
zsia
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of a (owner or contract buyer)
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 contrail seller(applicant must have been buying an 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
910..1g- 13-620o—to I. 0a3-e:9_5"
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or 8160,000 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 Ned for any other deductions? If Ws,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
111 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 of applicant Address of applicant (number and street,city,state,and ZIP code)
XSig X10'7 W (055 S of 4?bte?
ure of authorized repftentative Address of authorized representative (number and street,city,state,and VP code)