Age_Smith AtAPPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
°� PROPERTY TAX BENEFITS
State Form 43708(R10/12-08)
� on ` Prescribed by the Department of Local Government Finance
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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.
INSTRUCTIONS: 8 c
To be filed in person or by mail with the County Auditor of the county where the property is located. OCT 2 8 2016
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 6-1.1-7 or manufactured homes not assessed as real property:)4yring Ih months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Type of benefit requested(please check all that apply) -y�
DDver 65 Deduction from Assessed Valuation >g-r�ver 65 Circuit Breaker Credit
Name of applicant(owner.J/ contract
`-'buyer) — / ( `/'��Y�J
Is applicant the sole legal or equitable o If No,what is his/her reexact�/share or interest? If owned with someone other than spouse,
,,y, (((7 indicate with whom
V`4 Yes ❑ No
If 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(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
teal property ❑ Mobile home(IC 6-1-1-7)
Taxing dis ct Key number/Legal description Record number Page number
1n1L z6-aa-2k-360- c / CO/ 6;1/ •
Is the properly used and occupied primarily for Assessed value of the property as of March 1.current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or 5160 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
Have you filed for any other deductions? If Yes,what deductions? !/
' Yes ❑ No
I ei i ii
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 applicant Address of applicant (number and street,city,state.and ZIP code) r/7 /3
Se-"(e- -1 "A8 926 V S sr 4/ s7 6/6e Add 17,)
Signature of authodateTepresentative Address of authorized representative (number and street,city,state,and ZIP code)