Age_Baker 4`" t APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
' PROPERTY TAX BENEFITS
r` State Form 43708(R13/4-15)
fin. , Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
FILED
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located. ff1�,,��l(��
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and tiled or postmarked by the 1pit/v'n2 Ina*.
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. GIBBON COUNTY AUDITOR
Type of benefit requested(please check all that apply)
'Over 65 Deduction from Assessed Valuation ' Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) 7 f2) l
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
I% Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
iX-Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number/Legal description Record number Page number
D a.4-et G J ado -/y49 -god -00% o6d -o 0 7 •
Does applicant reside on property '
Have you filed for any other deductions? If Yes,what deductions?
., --Yes ❑ No /—ti j r M f y
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes eCe
INMe certify under penalty of perjury that the above and foregoing information is true and correct.
V Signature of applicant Address of applicant (number(number and street,city,state,and ZIP code)
Signature of_autnorized representaly fr) Address of authorized representative (number and street.city,state.and-IP code)