Age_Hartig dj, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR I
ir .
PROPERTY TAX BENEFITS
a y State Form 43708(R10/12-08)
ai ' 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. g T
INSTRUCTIONS: FILED
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 to bet/ble. P016
2) Mobile Homes assessed under IC 6-1.1-7 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.
GIBSON COI I j y AUDIT�H
Type of benefit requested(ple check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) y\
R 1 i
Is applicant the so a legal or equitable R If No,what is his/h act share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
II name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(9 year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property I I Mobile home(IC 6-1-1-7)
Taxing district I Key number/Legal description I Record number Page number
\I\CLar 6-a3 -06-3 oo -000.g?&-cj
Is the property used and occupied primed y for Assessed value of the property s of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes No
Was the applicant 65 years of age or more on December of the year
❑ Yes ❑ No
1Me 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)
•
I g. . FYI
Sinter -�^• t -'-- I Address of authorized representative (number and street.city,state,and ZIP code)
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