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�` `r, r1 APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
1 � PROPERTY TAX BENEFITS
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State Form 43708 (R19/7 25)
'ili•- Prescribed by the Department of Local Government Finance CD.tb3011
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)
Over 65 Credit Q' -Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
aii;"; ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in C mo Reside on the Property?
es ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property U •er Recorded Contract
for at Least One(1)Year before Clai • C - •it?
g Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZiP code) lithe Property in Question:
-; O.fteal Property ❑ Mobile Home (iC 6-1.1-7)
Taxing District Key Number i Legal Description Record Number Page Number
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Did Applicant qualify for the homestead st ndard 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 �r 'YeS ❑ 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? 2 Yes ❑ No
Signature of Applicant \ �' Date (month: day, year)
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Address of Applicant (number and street, city, state, and ZIP de)
C Signature of Authorized Representative ' Date (month day. year) 'LEDAddress of Authorized Representative (number and street. city, state. and ZIP code)
DEC 0 9 2025
Signature of County Auditor 1 _\7) Date (month, d(/aa . year)
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer C?-)\\