Age_Bennington tit APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
ki ? State Form 43708(R13/4-15)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
FI `
INSTRUCTIONS:To be riled in person or by mail with the CountyAuditor of the county where the property is located. ``II�vv 77 �rO1,,��
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the follM9Mg Jarga3lp.7
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. n/ n
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITnR
Type of benefit requested;;(please check all that apply)
-t_�' �Over 65 Deduction from Assessed Valuation r� Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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?
❑ 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 n No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
jJ- Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
b —0 a 6 -6/-/8- 12O/-0o/. ass- Cc 7
Does applicant reside on props 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
Yes Li 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?
l Yes ❑ No //-
Have you filed for deductions in any other county? If Yes,what co ?
❑ Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur of applicant •Address of applicant (number and street,city state,and ZIP code)
Signature of authorized rep tabus Address of authorized representative (number and s reef,et to ,and ZIP code)