Age_Grffith 7N. APPLICATION FOR SENIOR CITIZEN C?UNTY iFiwtHicEitR
` 4. `' PROPERTY TAX BENEFITS
Qn 2State Form 43708(R16/1-23) S oft 3
\.\-'•,!� Prescribed by the Department of Local Government Finance 7 2 7 2023
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 county auditor of the county where the property is located. -/tti( a J/V nd)
GIBSON COUNTY AUDITOR
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following
January 5 of the calendar year in which the property taxes are first due and payable.
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
e of Appli a t(rjwner or ntract buyer Telephone Number Emai ddress
Is Applicant 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 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 Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? EYes E No
Address of Contract Seller(number and street,city.state,and ZIP code) Is the Prope y in Question:
7 eat Property E Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
paw ;,1b - /q_!8 -a03 _ 000 . ,--/08 00 7
Does Applica Re de on operty? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
$199,999(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and S199,999[al
Yes U No Indiana real property)for the
Have You Filed for Any Other Deductions? If Yes,What Deductions?
es ❑No H S.
Have You Filed for Deduction in Any Other County?? If Yes,What County?
❑Yes Er‘
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature f Applic t � 4.40,/,,,,,,d // r / Date(month,day,year)
r 2••v �1 (0/� 7/ ✓Addres of Applicant(number and street,city.statP code)
130 E. TiRs r stj G 4(6_ANI cr-t">()- N Y 7 b--4.a .
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of Cpun Auditor (� Date(month,day,year)
X.'16 /2 4/1 r . . . I
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer