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Age_Koeling '> APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS • State Form d3708(R1917-25) Gibson Barton 2025 '•.• 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 clue and payable. See reverse side for additional instructions and qualifications. Type of Benefit Requested (Please check all that apply) ©Over 65 Credit ©Over 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 Name of Contract Seller Has Applicant Owned or Bought the Plui ity Under Recorded Contract for at Least One(1)Year before Claiming Credit? El Yes El No Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question. Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number ! Legal Description Record Number Page Number Barton 26-20-11 -100-000.420-001 Did Applicant quality for the homestead standard deduction in the preceding year (or was applicant mamed 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 quality for the homestead standard deduction in the current year? Is the Applicant 65 Years at Age or More on December 31 of the Year Pnor to the Year Taxes are First Due& Payable? ❑Yes ❑ No I/We certify under penalty of perjury that the above and foregoing information is true and correct. Sight a Applicant Date (month. day, a,4(Dtaik Z:)A.A,(A aza- /7,2 // D Address of Applicant (num r and street, city, state, and ZIP code) r , F 5791 S 1000 E, Oakland City, IN 47660 �J Signature of Authorized Representative Date (month. day year}EC 1 2 2025 Address of Authorized Representative (number and street, city, state. and ZIP code) Signature of County Auditor Date (month, dc} P� COUN T Y AUDITOR rr DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer