Age_Ping (2) Reset Form
`'P APPLICATION FOR SENIOR CITIZEN coNTY TOWNSHIP YEAR
47a. . PROPERTY TAX BENEFITS
) 50�1 0 11
.� ''1 State Form 43708(R18/9-24
'• 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.
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Please check all that apply)
EV6iver 65 Deduction
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
111!‘ ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
t ❑ Yes ❑ No
Name of Contract Sell r Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
\
One(1)Year before Claiming Deduction? Lr es ❑ No
Address of Contract Sell r(number and street,city,state,and ZIP code) Is the erty in Question:
1\`(- f ‘al Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
v Does Applicant R&siE e 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,
es ❑ 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 Applicant 65 Years of Age or More on December 31 o e Year Prior
Yes ❑ No 44 - ) APR 0 7 2025
Have You Filed for Deduction in Any Other County? If Yes,W at County? � -)
/
❑ Yes No y�� /
I/We certify under penalty of perjury that the abov and foregoing information is true and correct. ir/La%u L 2. 1
GIBBON COUNTY A nITOR
Signatu ppli nt Date(month,day,`yee(ar)
COI' w— f .a.
Addre of plicant n rand street,city,state,and IP c
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)
UJI a . \ \L ry --/- ate_
it
•
DISTRIBUTION: Original—County Auditor, File-Stamped Copy—Taxpayer