Age_Sensmeier dam \ APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
t4 PROPERTY TAX BENEFITS
;Ask./ State Form 43708(RI3/4-15)
a: Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. i'ILIrT�
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located. � Y 1 Z017
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the f ring January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(1 m s
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. GIBSON 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)
,Con /
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
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?
0 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?
CI Yes 111 No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
j3t2eal property ❑ Mobile home(IC 6-1-1-7)
Taxing distri Key number/Legal description Record number Page number
Y0 &4-&O.3O W asa Oioa oo/
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
CI Yes ❑ No 65 Circuit Breaker Credit.)
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 M S
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes r) No
IANe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street.city,state,and ZIP code)
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Sig turid re of authorized re resentative Address of authorized representative (number and street,city,state,and ZIP code)