Age_Kruse •
0 . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
? PROPERTY TAX BENEFITS
• *4 � State Form 43708(R13/4-15) ILA
I Prescribed by the Department of Local Government Finance ab5M
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 signedby 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)
1 Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
i E ',lift:, —
Name of applicant(owner or contract buyer) '
IF
Q)aletL /ruso. ' : .. . it
Is applicant'the sole legal or equitable owner? If No,what is his/her exact share or interest? If ownedw'h jiinflemt or tenant in common,
in r w1 o
,Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint to is or ten om r ide on the property?
GIBSON COUNTY A ❑ 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) _ Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing dist'ct Key number/Legal description 00 Record number Page number
on
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
,- ❑ No 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on Dec mbar 31 of the year
Have you filed for any other deductions? yf. s,
If Yes,what deductions? '�1�
Yes ❑ No "i`t�1 � 4- / l
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes Xl....19
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant t Address of applicant (number and street,city state,and ZIP code)
2--SO 9 5'4 ffit; Flafto.. r
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Signatur of thorized r presen ti Address of authorized representative (number and street,city,state,end ZIP code)