Age_Karcher "° APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
of PROPERTY TAX BENEFITS
0 C)a'`; qS State Form 43708(R16/1-23) 1P-N 2
\.,
rem 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 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 he all that apply)
Over 65 Deduction from Assessed/ '^Vealuation Over 65 Circuit Breaker Credit
Name o Applicant(owner or contract b yer)
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? ❑ Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is th P operty in Question:
eat Property LI Mobile Home(IC 6-1.1-7)
Taxing Di trict K,c_y Number/Legal Descriotion Record Number Page Number
Does Applicant Re ide 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 Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applica 6 Year of Age or More on Decem 3 of the Year Prior
$
Have You Filed for Any Oth Deductions? If Yes,What Deduct' s?
11
Yes 0 No
Have You Filed for D tion in Any Other Co my If Yes,What County?
es No
I/We certify under penalty of perjury that the bove and foregoing information is true and correct.
Signature of Applicant,, -.t ze. . r Date(month,day,year)
A dress of Applicant(number and st eel,city, le..:and ZIPode)
Signature of Authorized Repres tive Date(month,day,year)
Address of Authorized Representative(number and street,\"11 iv)-z- 6city,state,and ZIP code)
Signature o�C untyY 't Date\( Dolt,ry,y arL
FJAII-
A
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer N 0 V 1 8 2024
/ ZILI.0 a J/Yi'
GIBSON COUNTY AUDITOR