The URL can be used to link to this page

Age_Corne Reset Form "''4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR ;4+ 1 PROPERTY TAX BENEFITS ' • i s.- State Form 43708(R18/9-24) L1 1-I� L �y�, •" 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. 1 4 UO, C]GC1 1 �, 1� .,.©w . See reverse side for additional instructions and qualifications. O M Ole_ Q n 470 % 1°e-i n r. Type of Benefit Requested(Please check all that apply)ve c/ b� r 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit e- Lry e of A plican wnerorcontract buyer) Owned with Joint Tenant or Tenant in Common,Indicate with Whom PP 9 q es El No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common esdde on the Property? es ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least es One(1)Year before Claiming Deduction? ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: E -1 al Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number ni add: .�1)- ©O—a cU"' . 9 lo\ -tc09 . 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, 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 of the Year Prior W Ye' s ❑ No c04(NCY' IC— —\ - � Have You Filed for Deduction in Any Other,ounty? If Yes,What County? ❑ Yes ►. No 4111/4 I/We certify under penalty of perjury that tom: above and foregoing information is true and correct. Signature of Applicant Date(month,day,year) • VC'ak,e.t- „RS.4....4a Come_ W -I , Address of Applicant(number and street,city,state,and ZIP code) OT1 S. r�.in-ir-h .) cdi-f J .. �-t LOCI Signature of Authorized Representative Date(month,day,year) • Address of Authorized Representative(number and street,city,state,and ZIP code) FILE D Signature of County Auditor Date month,day,year) i AP vy*D' R 15 2025 G/u 1,: �1 i�/� DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer Gt!� LG. ��' GIBSON COUNTY AUDITOR