Age_Nellis >nA APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR •
.-'E'er. PROPERTY TAX BENEFITS
State Form 43708(R9/9-08)
•�leis Prescribed by the Department of Local Government Finance • ;1
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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. • A
INSTRUCTIONS: JUN 5 2014
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 -ba off f
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real pm ON.r121months
before March 31 of the year the deduction is to be effective. GIBBON COUNTY A Utl lJr�
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check al that apply)
1,4 I Over 65 Deduction from Assessed Valuation ® Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) 7°
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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�oofncontrect serer(applicant must have been buying on contract at toast one(I)year)
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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
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Is the property used a pied pr naJv(Dr Assessed value of the property as of March 1,current year(may not exceed$182,430
histher residence? tree::// 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
Adjusted gross income of applicant, spouse,and any
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes No
Have you filed for deductions in any other county? If 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 of a••'cant Address of applicant (number and street city:state,and ZIP code)
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Signs ure of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)