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-` " ''4. APPLICATION FOR SENIOR CITIZEN coup' T017D YEAR
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2s ' PROPERTY TAX BENEFITS r�Y 22s0-
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State Form 43708 (R19 / 7 25) �,� \)
'... Prescnbed by the Department of Local Government Finance -Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DEC 08 2025
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 �`60a ��
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which the property taxes are first due and payable. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
Over 65
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
g3 Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in ommon Reside on the Property?
Yes ❑ No
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Name of Contract Seller Has Applicant Owned or Bought the Prope Under Recorded Contract
for at Least One (1)Year before Claimi '. C edit?
r Yes ❑ No+ _
Address of Contract Seller (number and street. city, state, and ZIP code) Is the Property in Question:
Real Property ❑ Mobile Home (lC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
e..a-„.o P6 -/3 --f? . ;o/ - COO. a, 7 - 005
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?
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due & Payable? Yes 0 No
$
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
Signatu f Applicant Date (month, day, year)
X Q
id ess of Applicant (number and street. city, state, and P code)
-61u1 6 t%f/2)1) _,Z5c,c) Ai
406 .
Signature of Authorized Representative Date (month, ay, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor Date (month. day, year)
1),(Le ‘1,I 41. /e,e. )c.,4 /7/fic.. / 2. - F - .7_ ‘.5
DISTRIBUTION: Original — County Auditor; File-Stamped Copy - Taxpayer