HomeMy WebLinkAboutAge_Sandefer 4/ `-":Q,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
( 4 . ''I PROPERTY TAX BENEFITS
. -;l State Form 43708 (R19/7-25) r1 y--).D.c)
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73 /2.-
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Prescribed by the Department of Local Government Finance 1
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 (Pleaseme heck I!that apply)
ver 65 Credit Over 65 Circuit Breaker Credit
Na ff Applicant (owner or contra u r)
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
I/ Yes ❑ No
If Name on "ec. d is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Cm +n Reside on the Property?
PSI Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the P op= Under Recorded Contract
for at Leas! One(1)Year before Clai I . • edit?
11% Yes ❑ No
•
Address of Contract Seller (number and street, city, state. and ZIP code) Is the Property in Question:
• Real Property ❑ Mobile Home (/C 6-1.1-7)
Taxing District AN)'/)
Key Number/ Legal Description Record Number Page Number
�0� - '1 12-0 is - V 02 -- Q02 . L1-4 - - Q 2_8 .
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 Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant --
and joint tenants or tenants in common, as applicable (For Over 65 Credit, AG!
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct. ED ,
Signature of Applica t t Date (month, day. year)
ress of Applicant (num a et, city, ate, and ZIP code) UC r 0 9 2025
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Signature of Authorized Representative / Date (month, day, year)
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Address of Authorized Representative (number and street, city, state, and ZIP code) GIBSON COUNTY AUDITOR
Sign ure of ounty itor Date (m nth. ay, year)
\1\7--) -S- 12- ci ate?____ ...._
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer