Age_Ewin Azip APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R18(9-24)
me Prescribed by the Department of Local Government Finance LI bSeA COIL,"1,47-4).';'AS
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,signed,and filed with the county auditor or postmarked by January 15 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 all that apply)
E".1<er 65 Deduction from Assessed Valuation 1 }'<fer 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
ID Yes END
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common R side on the Property?
Yes CI No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? Lames El No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
t'A Pr , Real Property El 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$ 40,000 for Over 65 Deduction or
$199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,$199,999(all
Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023,
fili‘s El and$239,999[all Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2022.)See
reverse for details.
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior
VKI' s El No 4-kGro-sL4-C_a Cti
Have You Filed for Deduction in Any Other County? If Yes,What County?
0 Yes EP'CK4
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si ture of Applicant
.6.‘....,‘..........2....._ Date(month,day,year)
ge4
Address 6U • cr,'2_- 2_C2 -?..c)2,S"
of Applicant number and street,city,state,and ZIP code)
I . -
Signature of Authorized Representative - Da (month,day:year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,da,ty-7.IUD
-f-f\c-e_1(Nca.sh0 cl_ _ual_i-ILIzi(h.RbJ .z...._7
FEB 2 6 2025 .
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer N•irc.* *- !:? '
A,./../..e.a. fiL )
GIBSON COUNTY AUDITOR