Age_Wilkison (2) ;`_"'='o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
I: , ;p PROPERTY TAX BENEFITS
ti+ State Form 43708(R16/1-23) (�j�
• Prescribed by the Department of Local Government Finance J
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 all that apply)
Over 65
If Owned withJoint Te
nant q 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? Yes E No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Que on:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description / Record Number Page Number
0 0 k 26 -2 o a 7--Lt oo -001 Mt -op,
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
Yes 0 No Indiana real property)for the
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filed a joint return with the individual's spouse.)See reverse for details. TOTAL $
Have You Filed for Any Other Deductions? If Yes,W at Deductions?
Yes El No S •
Have You Filed for D u ion in Any Other Cou ty? If Yes, at County?
❑Yes o
I/We certify under penalty of perjury th t the above and foregoing information is true and correct.
Yi sture of Applicant 1 pV,O�� Date(month,day,year)
Ad ress of Applicant(numbers street,c., state nd ZIP code) `Y`
11t4 S qoo. , E� t _ v\
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(mont day,ye )
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FILED
MAY 2 42024
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
a )
GIBSON COUNTY AUDITOR