Age_Wilson esm Ret For "
4:4. El,� APPLICATION FOR SENIO CITIZEN COUNTY TOWNSHIP YEAR
$i '' � PROPERTY TAX BENEFITSR
• d State Form 43708(R18/9-24) ,)�4\ 0 V 2--- v�
'em Prescribed by the Department of Local Government Finance _ J
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
Type of Benefit Requested(Please hec all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant(owner or cont ct bu r) Telephone Number Email Address
Is Appli ant th 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 ❑ No
If Name on co 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 Un er Re d 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 e perty in Question:
eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
0 CD 2- Z 6-zo-\y - , -000. O gi -CD2
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 forOver 65 Deduction or
$199,999(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,$199,999 fall
Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023,
Yes El No 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 Applica t 65 Yes am of Age or More on Dece ber 1 of the Year Prior
$
annually adjusted.]See reverse for details.
Have You Filed for Any Othe Deductions? If Y attDDeductions?
Yes El No J
Have You Filed for ducti in Any Other Cou ty If Yes, al County?
❑ Yes ❑ o
Nile certify under penalty of perjury the the bove and foregoing information is true and correct.
Sign of A
,:C Date(month,day,Y '` -
`J f)�/1JC�r
¶ fApphcant(numberap,dçre11Y.stale,and Zii ode) , l
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZiP code)
Signature of unty Au i r c a..... , t IT 1T)
Date(mo i,day ^
t I/l�` uL [J/'�J Ll�
MAR 0 5 2025
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer
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GIBSON COUNTY AUDITOR