Age_McConnell (2) . - APPLICATION FOR SENIOR CITIZEN Epp Y
_ -. S PROPERTY TAX BENEFITS It-i, qLq
State Form 43708(R9/9-08)
S mi. I Prescribed by the Department of Local Government Finance
MAY 0 7 2%43 Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. ,1 d��
INSTRUCTIONS: {;, [
To be filed in person or by mail with the CountyAuditor of the county where the property is located. GIBSON COUNTY AUDITOR
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-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 benefit requested(please check all that apply)
14 Over 65 Deduction from Assessed Valuation "Over 65 Circuit Breaker Credit
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 c -,trail seller(applicant must have been buying on contract at least one(1)year)
Address of mntrad seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing trill v Key number/Legal description 'Record number Page number
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Is the property used and occupied primarily for Assessed value of the property as of Mardi 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or 5160,000 forth°Over 65 Circuit Breaker Credit)
Er Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for deductions in any other county? If 1es,what county?
❑ Yeso
WVe 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)
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Signature of authorized representative Address of authorized representative (nun street,city,state,and ZIP code)