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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTYTAX BENEFITS
^� State Form 43708 Rib/1-23)
'e'6 4. 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 check al that apply) .LN Over 65 Deduction from Assessed Valuation g.'Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
IJ4 ❑ 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
N`pf One(1)Year before Claiming Deduction? IJ'Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
LYKeP�al Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed S240,000 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(a!
in•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 Filed-for Any Other Deductions? If Yes,What Deductions?
es 0 No D( SC� tk'V-- --LA- i V a— AA
Have You Filed for Deduction in Any Other County? If Yes,What County? 111
Dyes 11114#
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant arLLfG� D to month,day,year)
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Ad ss of Applicant(number and street,city,state, nd ZIP P coueT
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(month,day,year)
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FILED
DEC 16 2024
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
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GIBSON COUNTY AUDITOR