Age_Miller •,-7''9. APPLICATION FOR SENIOR CITIZEN
d��-•<� COUNTY TOWNSHIP YEAR
a� �.'1j PROPERTY TAX BENEFITS /
�� '` ; State Form 43708(R16/1-23) Sal ! i- i,.fcI `1'•i• Prescribed by the Department of Local Government FinanceOg
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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 Deduction from Assessed Valuation X0ver 65 Circuit Breaker Credit
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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? J Yes ❑ No
Address ofontrrfacctt Seller(number andstreet,city,state,and ZIP c de)�/ { y /�y n Is the Property in Question:
eJ �i/ f'�LJ� �J I�1 RrNi�f", ('v `'t" `(7 r✓ Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Dag ai 6- /?- 6,7 :-000c a9�-cog
Does Applicant Reside on Property?
Yes ❑No CC..e
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑yes IN.No
1/We certify under penalt of perjury that the above and foregoing information is true and correct.
Signature of Applica / , 'r , Date(month day,yea)
d re of Applicant(number and street,ci y,state,and ZIP cod r/ •
Lie
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signet r ofCou ty Auditor i ( Date(m+yonth/ ay,yea/
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afie FILit
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JUL 29 2024
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
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GIBSON COUNTY AUDITOR