HomeMy WebLinkAboutAge_Richardson (2) ---69 T.s 7 z___ (4, < .... ,-2_i3 1 1 2_s-----
t„` "''CV APPLICATION FOR SENIOR CITIZEN OUNTY TOWNSHIP YEAR
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PROPERTY TAX BENEFITS
State Form 43708 (R19/ 7-25) la ,S uN 1 t3 2=6 2
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'•,• _ 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)
Jve 5 Credit I-0ver 65 Circuit Breaker Credit
Name of Applicant.(owner or contract buyer)
,
is_Applicant.the Sole Legal or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
es ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
s ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
a�es ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
al Property ❑ Mobile Home (iC 6-1.1-7)
Ta District Key Number / Legal Descnption Record Number Page Number
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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?
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due & Payable? S ❑ No
annually adjusted.]See reverse for details. TOTAL $
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month. day. year)
t
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and street city, state, and P ode
dress of Applicant (numbery. )
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Signature of Authorized Representative Da (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor Date (month, a , y r)
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DEC 0 4 2025
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer
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GIBSON COUNTY AUDITOR