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APPLICATION FOR SENIOR CITIZEN couNTV TOWNSHIP YEAR
y PROPERTY TAX BENEFITS I
b . ,
i� � State Fortn 43708 (R70/ 72-08) I
�O' Prescnbed by the Department oF Local Govemment Finance !
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: o
To be filed in person or by mail with the CountyAuditor o/ the county where Ihe property is locafed. �E� J �
Filing Dates: 7) Real Property: Dunng the Rve/ve (72) monfhs before December 37 0/ the year the deducfion is fo be e(leclive.
2) Mobile Homes assessed under IC 6-1 J-7 or manu/acfured homes not assessed as rea/ property: n Me
befo2 March 37 07 the year lhe deduction is to be eNective.
See2verseside7oradditionalinstruclionsandqualilcations. GIBSON COUNI
Type of Eeneat requested (p/ease check all thaf apply)
� Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant (owner w conhacf buyer)
�.�'���� � �%���
Is appliwnt Ne wle legal or equitable owner9 If No, what is hisfner exact share or interest? If owned wi;h someone other i an spouse,
indicate with whom
� Yes ❑ No
If name on record is diHerent than that of applicam, indicate below I
Name of conUact seller �pplicant must have been buying on contraci a( /easf one (7) year)
Address of mntract selle+(number and sfreet, uty, state, and ZIP code) Is the property in question:
� Real property ❑ A,
Taxing ais �ct Key number / Legal desaiption Record num0er
1� alo - aa-0�3 � I. � o� �(
Is the prope used and occupie0 pnmanly for Assessed value of the property as of March 7, wrrent year
hismer residence? �ar Over 65 deduction, or 5760,000 for fhe Over 65 Circaif i
� Yes ❑ No
Was the applicant 65 years of age or more on December 31 of Ne year
pnor to Ne year taxes are (rst due and payable?
� Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (For Over 65 deduclion, income
may not exceed 525,000; for the Over 65 Circuit Breaker Credit,
income may not exceed 53QOOO Io� individuals, or 540,000 tor
manied couples).
Have you filed for any oNer deductions?
❑ Yes
Have you filed for deduction5 in any other counly?
❑ Yes
❑ No
❑ No
0.00
was a resident
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