Age_Straw #` `'"',,4 APPLICATION FOR SENIOR CITIZEN
�};.-, a� COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708 (R19 / 7-25) C ., ),(?--0(-\r‘se,
..w....,
'•'• - 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.
See reverse side for additional instructions and qualifications. _
Type of Benefit Requested (Please check all that apply)
D6ver 65 Credit r 65 Circuit Breaker Credit
, Name of Applicant (owner or contract buyer)
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 Recorded Contract
k\ I for at Least One(1)Year before Claiming Cr 2
11 ❑'Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
W /
(� Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District 1 Key Number/ Legal Description Record Number Page Number
Cji 0 - - -- `-goo -0 - 0 eD LI .
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to ❑
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately es No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
i
$
I/V1/e certify under penalty of perjury that the above and foregoing information is true and correct.
Signa a of Applicant ' Date (month, day, year)
}i
Add e�Ss of Applic nt (number and street, city, state, and ZIP code)
ICti rt. I S0 \ACI__)._s___bi aCt, -� ._ i - �� 01
Signature of Authorized Representative , Date (month, day, year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
1
Signature of County Auditor Date (month, day, ye ) ED
siNci_sLs a . ),Da___4 \( 4...,, .. .—.) / A q — i & .
/
S E P 1 1 2025
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer (7221-azal. , . iltrit4;724)
GIBSON COUNTY AUDITOR