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e<":74--- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 4 :r A PROPERTY TAX BENEFITS ' _` G .I'D� 0 24- ‘ ay �\_ � State Form 43708(R16/1-23) � '•e• 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 I at dJ It Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the of • January 5 of the calendar year in which the property taxes are first due and payable. A I Ir 0 9 2 See reverse side for additional instructions and qualifications. AUG 024 Type of Benefit Requested(Please check all that apply) F Over 65 If Owned with Joint Tenant or Tenant in Common,Indicate with Whom es ❑ 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? LVes ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Pro erty in Question: Ud Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number 4-Fa /O&M 411 P , 6-J)- 17- 1/© .- o/- W 1-D.... 7 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 ❑ No Indiana real property] Yes No I1'O M e Sit.ec..-tf , Have You Filed for Deduction In Any Other County? If Yes,What County? ❑Yes & O I/We certify under penalty of perjury that the above and foregoing information is true and correct. atitrYg �� Q- g - Address of ApplIcanf(number and street,city,state,and ZIP code) I17)1L 150 .Sov� L Pf I nCgfort Id 2--/7 '' 0 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(mon�y,year) � q/(IGFILED � � z/ AUG 0 9,2024 DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer� Jf GIBSON COUNTY AUDITOR