Age_Gabbard Aii`0 7,4-°. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7. _' PROPERTY TAX BENEFITS
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1'1.7 State Form 43708(R16/1-23) J J
�!'•.!% Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DEC Q 4 2023
INSTRUCTIONS: To be filed in person or by mail with the county auditor of the county where the property is located.
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarke f/ tiL
January 5 of the calendar year in which the property taxes are first due and payable. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Pleas check that apply)
fff Over 65 Deduction from Assessed Valuation
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
El 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? ❑ Yes ❑ No
Address of Contract Seller(number and street,city.state.and ZIP code) Is the� Poperty in Question:
e' Real Property E Mobile Home(IC 6-1.1-7)
Ta District Key Number/Legal Description Record Number Page Number
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Does Applicant Reside on Property'? 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$199,999(al
:Y('6 LJ No Indiana real property]for the
Have You Filed for Any OtherDeductions? If Yes,What Ded io
19res El No - J f• % . 1)1k14a4lip
Have You Filed for Deduction in Any Other County? If Yes,What(ounty.
❑Yes ILK"-
ldiq ��� (1- '`I/We certify under penalty of perjury that the above and foregoing information is trub'an rr ct.—
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Signature of Applicant � �/�� ] J3 D to(month,day,year)
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Address of Applicant(number and street,city,state,and ZIP code)
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Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor • Date(month,day,year)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer \
