Age_Tenbarge -'`' APPLICATION FOR SENIOR CITIZEN ,
L COUNTY TOWNSHIP YEAR
i PROPERTY TAX BENEFITS ---- --t I
V
;�, State Form 43708(R16/1-23,
k.sus G/b 5e>n //avbs �- .79
Prescribed by the Department of Local Gc dement Fna`.c- �
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
Type of Benefit Requested(Please check at'that apply)
/er 65 Deduction from Assessed Valuation _—Over 65 Circuit Breaker Credit
Name of Applicant(owner Cr ccr'ract buyer'
If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
_ Yes _ No
If Name on Record is afferent than Applicant.Indicate Below Do All Joint Tenants ar Tenants in common Reside on the Property?
•
- - -- - Yes =! No
Name of Cort-act S=_I!e I Has Applicant Owned or Bougrt the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? �g
I----- --- _' No
Address a'Contract Seller(number and street city.state and ZIP code' Is the Pr erty in Quest.on
Real Property _ Mobile Home(IC 6-1.1-7)
Taxing District Key Number!Legal Descr;• - Record Number Page Number
(44 )104A- 4- A-.Ft-31- 3o1-cw. 533-c ?
Does Appl cant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed S240.000 fcr Over 65 Deduction or
_ 5199.999[counting lust the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2026 and 5199,999[al
Xs _ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31.2019.)See reverse for details.
Is the Applicart 65 Year of Age or More on December 31 of the Year Pnor
,
filed aioint return with the individual's spouse)See reverse for details. TOTAL S APR 19 2024
Have You Filed for Any Otherer�Deductions? If Yes,What Deduction
__ G/1/
2.Yes ❑No
Have You Fled for Deduction in Any Other County? If Yes.What Count GIBBON COUNTY AUDITOR
❑yes o
•
9_ Z r _
MJ Ie certify under penalty of perjury that the above and foregoing information is true and rect. 1
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Address of Applicant(number and street."city s te. and ZIP code) `
1P N \J S — 144)..,A$5N- I4- 'TAi 47C3q
Signature of Authorized Representative 'Date(month. day.year)
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Address of Authorized Representative(number and street c ty state and ZIP code.
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' a gnat:re or C nty A.;:itcr day —
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DISTRIBUTION: Original -County Auditor: File-Stamped Copy-Taxpayer