Age_Michel C ,k APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
1 _ PROPERTY TAX BENEFITS
1� If o
' State Form43708(R13/4-15) �� 1 1"I
s 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 CountyAuditor 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 by the following January 5.
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.
• Type of benefit requested(please check all that apply)
❑ Over 65 Deductio om Assessed Valuation Over 65 Circuit Breaker Credit
o ne er exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No
If name on record is differen han at of appli mat elow Do all joint tenants or tenants in omm reside on the property?
Yes ❑ No
Name of contract seller Has applicant owned or been buying the roperty under recorded
D C T 2 5 �019 contract for at least one(1)year bef re aiming deduction?
Yes ❑ No
•
Address of contract seller(number and street,city, +e,and ZI cod) • Is the grope n question:
GIBBON COUNTY
AUDI` Real property El Mobile home(IC 6-1-1-7) '
Taxing district Key number/Legal description Record number Page number
•
f `A-0 via 6-11.11.-LW2..-00 1 . 1731-02.s
Does'ajpiicant reside on property?
❑ Yes ❑ No
INVe certify under penalty of perjury that the above and foregoing information is true and correct. X,
Signature of applicant Address of applicant (number and street,city state,and ZIP code)
,406 S Srilf Sfi fi\ � - JV) - .�-�
Signature of authorized representative Address of authorized representative Wer and strait,city,state,and ZIP code)
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