Age_Melton E'":"a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR '
:;`',7 :% PROPERTY TAX BENEFITS
Its s State Form 43708(R9/9-08)
'cis 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 tied in person or by mail with the County Auditor of the county where the property is located.
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Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to beeeectrve
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prop Du g g the twelve(12)months
before March 31 of the year the deduction is to be effective. 1 2014
See reverse side for additional instructions and qualifications. n
Type of benefit requested(please check aD that apply) „'(/ M _
�-{ GIBSON COI Lit Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker W8il , AUDITOR
Name of (owner or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? owned with someone other than spouse,
i ndicate with whom
44 Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of wmrac seller(applicant must have been buying on contract at least one(1)year)
Address ct seller(number and skeet,city,state,and ZIP code) Is the property in question:
kJ 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 and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residenoa? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
IN Yes ❑ No
was the applicant 65 years of age or more on December 31 of the year
❑ Yes ❑ No
IAVe 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 .
Sign rcant Address of applicant (number and street,oily,state,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and street,city,state,and ZI%cfode)