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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R18/9-24) ' 30(1 CO+ L
' 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
Type of Benefit Requested(Please the all that apply)
Over 65-Deduction from Assessed Valuation Oder 65 Circuit Breaker Credit
N me of Applicant o ner^oVrrccoontr ct uyer) `TelephoneNumber Ema Address
2,1
Is Applicantthe Sole gal or Equitable Owner? f 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 Record 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 Und r ecorded Contract for at Least
One(1)Year before Claiming Deduction? Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) I the roperty in Question:
Real Property ❑ 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$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,
Yes ❑ 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 ears of Age or More on Decem er 1 of the Year Prior
annually adjusted.)See reverse for details.
Have You Filed for Any ther Deductions? If Yes h Deductions?
Yes ❑ No J` •
Have You Filed for De uc in Any Other Co my. If Yes,Wh County? (� h1 �, L_
❑ Yes No \ S S�c�4-11 'V K-� O`CN'h� Q 1 \ 3�_ L} V c
I/We certify under penalty of perjury tha the above and fo egoing' ' true and correct.
Signature of App nt f pate(month,day,year)
T
Address of Applicant(number and street,city,state,and ZIP c de)
\./ APR 2 1 2025
Signature of Authorized Representative �� Date(month,day,year)
Address of Authorized Representative(number and street,city,state,anp�� kk�C c2
GIBSON COUNTY AUDITOR I
Signature of Co it f Date(ma/7th,day,year)
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer Q...)\