Age_Pride �`""'a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�1 '1 PROPERTY TAX BENEFITS
�i ,;,,/ State Form 43708(R16/1-23) I (r_ tV),�^ COC
--fire...--' Prescribed by the Department of Local Government Finance +
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.
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. 1 LA t 00 D
Type of Benefit Requested(Please check all that apply) -
alUvka�er 65 Deduction from Assessed Valuation .el .ver 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
Joint Tenants or Tenants in Common Reside on the Property?
Yes 71. No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? eS E. No
Address of Contract Seller(number and street,city.state.and ZIP code) Is the Property in Question:
_
• eal Property _ Mobile Home(1C 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Q& mho 1 0L . .&DO- 1 ".A\ 1 Cn'-'.—1 0 l - i 43(R'COCX2
Does Appl;cant 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 1,202G,and S199,999[al
Yes —, No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December1, 31 of the Year Pnor
—
Have You Filed for Any Other Deductions? If Yes,What Deductions'?
nrYes El No k \QN-'(\
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes /tiNo
I/Wthat e certify under penalty of perjury the``"` above and foregoing information is true and correct.
Si natur f Applicant / Date(month, day.year)
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A die of Applicant(number and street,city.state.and ZIP code)
•
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Signature of Authorize epresentaf,ve / Date(month. day,year)
I i_ ILED
j Address of Authorized Representative(number and street.city,state,and ZIP code)
Signature of County Auditor ' Date(month, day year/
a ••\ 64j;°L-L1L°/ MAR 5 2024
`7t. a
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer