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;t 1. P4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
.; State Form 43708(R18/9-24)
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a'• Prescribed by the Department of Local Government Finance , .��y',
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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. C I 1 0� '0 4,, ' tf`(`{ c>s-\Q ,\
Type of Benefit Requested(Please check a!that apply) E 1 ""2. ` 1
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
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?
E/Vcs ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? gs ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Pro erty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Keyr Number� /Legal Description Record Number Page Number
—,OAt' N&) 01
-(1 O — o1 3- ILP - \ OO- ocO 1-Q - .
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 fall
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 Years of Age or More on December 3 of the Year Prior
A es ❑ No - ( X \(. .1:_i\CI- -
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑ YesQ
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si nature f Applica iDate(month,day,year
Add s Applicant num ran street,city,state,and ZIP co e) /
e -4 , 0.e..Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code) 11II1.EI�
dtorDate(month,day,year
Signature of County Auditor
CP SN C , F. La -cw - a�.
APR 2 8 2025
DISTRIBUTION: Original—County Auditor;File-StampedCopy—Taxpayer (7274:a ,G.e a �Y nd)
GIBSON COUNTY AUDITOR