Age_Winstead Reset Form
9 ""'am. APPLICATION FOR SENIOR CITIZEN
' ICOUNTY TOWNSHIP YEAR
at' -':-I'l PROPERTY TAX BENEFITS /�
State Form 43708(R18/9-24) T 0 v/�t c2 145
416 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,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.
(539
See reverse side for additional instructions and qualifications. " 1 (coo —
Type of Benefit Requested(Please check Ii that apply) `�
lV Over 65 Deduction from Assessed Valuation ❑t= v9 er 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
Owned with Joint Tenant or Tenant In Common,Indicate with Whom
❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
1[2<s ❑ 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
ofContract Seller(number and street,city,state,and ZIP code) Is h .Property in Question:
(
\P— Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Pl V4 10_ I0 '34. -LACO-®4l. 4 lc) D- O
Does Applicant Resid 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,$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,
TX; ❑ No and$239,999 fall 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 the Year Prior
1 ,f 1 ®�QQ
R Yes ❑ No - S I I,�3 � 1 1\ �`� `i J Ji&)Have You Filed for Deduction in Any Other County. If Yes,What County? LL//
❑ Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sigi ure of Applicant Date(month,day,year)
., 1/17 x -'- ate.
Address 4f Ap icant(number and street,city,state,and ZIP code)
1--12—M � le .) J . �� 1X��
Signature of Auth'Srized Representative vote(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,y r ETA
r.A.,,,,,,sta• bs_ aiiiL,AM/fl.c?s,..,) ---- - -- -
MAR 0 3 2025 �� -
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer r7 ,,!/r `�
(�LQ.GL a. ,!�(r�. 4)
GIBSON COUNTY AUDITOR