Age_Holderbaugh oQ ^ s �� APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS 1 ( ;
,z.,f.,-,; State Form 43708 R16/1-23 \ i
s� Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DEC 0 6 2024
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 postmar� 112eaJ/lr ;n4)
January 5 of the calendar year in which the property taxes are first due and payable. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Please check all that apply)
'Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant wner or contract buyer)
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
,'Yes El 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.the Property in Question:
1 Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxis istrict , Key Number i Legal Description Record Number Page Number
e o-f; -/8 -.10/ - co/. / 9 7 - or. 8
Poes 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
5199,999(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 Applicant 65 Year of Age or More on December 31 of the Year Prior
$
Have You Filedfor Any Other Deductions? If Yes,What Deductions?
Oyes ❑ /No ! • s •
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes No
I/We certify under penalt of perjury that the above and foregoing information is true and correct
/\ Sign re•f Agplican Date(month,day,year)
.%4h -i-, .1._--
/ Addre s ofAp lira nai.er and street,city,state a P code),2 0? . 01 diiex.J.,1z-.. /2,./ize' d, -L)017).7, -51---7- 6-74
Signature of Authonzed Flepresentative / Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of Cqunt AuditorG� L
Date(month,day.year)
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer csk