Age_Slone , ".7-°.. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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PROPERTY TAX BENEFITS
State Form 43708(R16/1-23)
ram 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
,
' Type of Benefit Requested(Please c ec I that apply) ,
-Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Nsree of Applicant(owner or cont- ct yer) Telephone Number / E il Address
Sr .
( )
Is pplicant th S e Legal or Equitable Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Yes El No
If Name on eco is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
l=I Yes 1=1 No
Name of Contract Seller Has Applicant Owned or Bought the Property +der';corded Contract for at Least
One(1)Year before Claiming Deduction? .4 Yes LI No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t e operty in Q -stio,:
Real Property II Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Does Applicant es" e on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
Yes El No $199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al
Indiana'real property)for the
$
Have You Filed for Any et er Deductions? No IMWhat Dedtol c Cb \\
I Yes El - l - Y
Nf IC `)
Have You Filed for De,ucti• in Any Other County? If Yes,.Whal Co ty? /
Dyes El No
I/We•- under penalty of perju let the above and foregoing information is true and correct.
Sig re of•pplicant' f
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Aid - of Applicant(numbe and str et,city,state,and code) Date(mo i f, le ED
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EC 10 2024
Signature of Authorized Representative / Date(month,daP yedr) ''"'
Address of Authorized Representative(number and street;city,state,and ZIP code) \//24,4e a iiraytiHrtd)
GIBSON COUNTY AUDITOR
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Signature o Coun Auditor
Date(montyear
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer