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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e PROPERTY TAX BENEFITS
�� � State Fortn 43708(R73/4-15)% ���
:-: Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
APR 16 2019
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by4). fouowa._�'-.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as realproopert . &.' •'+' a(12)months
before March 31 of the year the deduction is to be effective. GIBBON CO NTY AUDITOR
See
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:
.k Real property ❑ Mobile home(IC 6-1-1-7)
Taxing di Key number I Legal description Record number Page number
a6- /a -/7 -ID! -oo/. YV - 01- $
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 3159,999(counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit.)
YesSee reverse for details.
Is the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day.year) If filed by a surviving,unmarried spouse,what
prior to the year taxes are first due and payable? was the spouse's age at the time of death?
AYes ❑ No
Adjusted gross income o app ic�l ant,applicant and spouse, or Source of Income Amount of Income
applicant and joint tenants or tenants in common,as
applicable(For Over 65 Deduction, income may not exceed /O y 0
See reverse for details. I TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
NrYes ❑ No /I S M-f
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 of applicant Address of applicant (number and street,city,state,and ZIP code)
ya e Address ��
Si� re of authoriz represen a Address o authorized representative (num and street,city,state,and ZIP code) 117 G7
11,1 _I lift . ^ '7