Age_Nixon Reset Form
""' APPLICATION FOR SENIOR CITIZEN
,�_:��:�'� COUNTY TOWNSHIP YEAR
d , :1i; PROPERTY TAX BENEFITS ,
N? State Form 43708(R18/9-24) C O„^ Q
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ter Je 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: Fomi must be completed,signed,and filed with the county auditor or
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Type of Benefit Requested(Please hec all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
N e of Applicant(ow r or cont t b er) Telephone Number all Address
11)/NOn ( )
Is p i the Sol Legal or Equitable Owner? If No,What is His/Her Exact Share or Interest?Isj
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 Under: riled Contract for at Least
One(1)Year before Claiming Deduction? Lt Yes 0 No
Address of Contract Seller(number and street,city,state,and ZIP code) I the Property in Question:
Real Property ❑ Mobile Home(/C 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,
Kos 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 Applicaars of Age or More on December of the Year Prior
❑ Yes ❑ o
I/We certify under penalty of perjury th the bove and foregoing information is true and co
Signa a of Applicant f
t�(m th,d aFD
Address of licdht nu erands eet city,state and ZIP code
60°(Signature of Author'Irized )Dr\ k d-\ - '� • JUN 2 3 2025
g RepresentativeDate(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code) /22,-C 'O ""/a
GIBSON COUNTY AUD OR
Signature f ountyditr_ \ / 4 Date(mon �(ay,year)• ^�, -
tv,`Jit rit' lam) i l�^JI `J�.. (nJC ��
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer