Age_Folkman ` -", APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR _
ce , PROPERTY TAX BENEFITS
::
\ +' State Form 43708(R7314-15)
• \'®° 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.
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the propert Focc e��D
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prwry:®tinglig twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. fyem
Type of benefit requested(ple a check all that apply) GIBBON COUNTY AUDITOR
Over. 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract r
"1.44CEA..� I+ t � eitiefMain
Is applicant the sole legal or eq-itable owner? If No,w•.t is is/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
❑ Ye ■ h.•
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
V4 ❑ 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) I Is the property' question:
1 A r ' I/���A I• o ll`I o` [j Real property ❑ Mobile home(IC 6-1-1-7)
Ta ' strict _lh!-' 1 l `tip CCJJ`` iiKeJeynunumber/ al plasm jon Record number Page number
a- II-G -161E-000.54i8flaS'
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
5182,430 for Over 65 Deduction or 5159.999(counting just the homestead site]for the Over
rYes ❑ No 65 Ciicuit Breaker Credit.)
I�
See reverse for details.
Is 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
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.
Signature applicant �,ry Address of applicant (number and street,city,state,and ZIP code)
Signatu of of a�representative Address of authorized representative (number and street,city,state,and ZIP code)