Age_Graper o r"�� APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
�� PROPERTY TAX BENEFITS
o� ie Slate Form 43708(R19/7-25) Z
V.a's Prescribed by the Department of Local Government Finance `k 1 iQ\0 �p e
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/5 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)
,IROver 65 Credit It Over 65 Circuit Breaker Credit
Name of Applicant owner or contract buyer)
Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
VYes ❑No
If Name on Record Is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants In Common Reside on the Property?
tgl Yes ❑No
Name of Contract Seller Has Applicant Owned or Bought the Property Udder Recorded Contract
for at Least One(1)Year before Claiming Credit?
Yes ❑No
Address of Contract Seller(number and street city,state,and ZIP code) Is the P perty-In Question:
el. ,Affl,Real Property ❑:Mobile Home(lC 6-1.1-7)
\.....4....% T/'g District / K./TWO /(,(.r.9j eyNumber/Legal Description Record Number Page Number
• Applica t qual' for the homestead standard deduction In the preceding year(or was applicant married at the time of death to
a deceased-spou who qualified for a homestead standard deduction for the Individual's homestead property in the immediately g Yes 0 No
preceding calendar year)and does Applicant qualify for the homestead standard deduction In the current year?
Is the Applicant 65 Years of Age or More on December31 of the Year Prior to the Year Taxes are First Due&Payable? iin'ps 0 No
$
I/We certify under penalty of perjury that:the above and foregoing Information is true and correct
Signature of Applicant Date(month,day,year)
Ad ress of Applican number and skeet,city,s't,and ZIP code)
346
iN
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)
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DISTRIBUTION: Original—County Auditor,File-Stamped Copy—Taxpayer FILED
AUG 062025
` 22 a. �
GIBSON COUNTY AUDITOR