Age_Bottoms 4!`"'' a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
xa . -`� PROPERTY TAX BENEFITS -
sr.1k. " State Form 43708(R16/1-23) \ ��V'\ 0 0 ( L ]ZL(
1814 Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. v
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 chec all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
e of App(lica t(ownontr yer)
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Yes ❑ No
If Name on ecor 's 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 ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t Property in Que on:
eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District 0 0 y umber/Legal Description Record Number Page Number
Does Applicant Re ' e 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]for the
$
Have You Filed for Any Other Deductions? If Yes,W t Deductions?
Yes ❑No S.
Have You Filed for D uc'on in Any Other C un ? If Yes, at County? 0 C T 07 2024
Dyes No
I/We certify under penalty of perjury t at t e above and foregoing information is t d corre t�' ,
Signature of Applicant GIBBON COUNTY A191�3f'f(tth,day,year)
Address0,3„,.„41. A. (a,-/ -)-0,4_,
QQ of Applicant(number and street,cif te,and ZI code) o�
rit
GJI�'g L l0D sy � V�
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of Cou t Audit r Date(nit
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer