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Age_Rich Y ril _ 6 i 143 12 � ".''„ APPLICATION FOR SENIOR CITIZEN 0 PROPERTY TAX BENEFITS f -� ; COUNTY TOWNSHIP YEAR 601/1\ "\6-1\ 41\- S. �' State Form 43708(R19/7 25) \(- 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, s►gned, 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) El'6ver 65 Credit ©-Over 65 Circuit Breaker Credit me of Applicant ow r or contract buyer) 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? ❑Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One (1)Year before Claiming Credit? pyves ❑ No Address of Contract Seller (number and street, city, state, and ZIP code) Is the Pr"stly in Question. 0-Real Property ❑ Mobile Home (1C 6-1.1-7) Taxing District Key Number/ Legal Description Record Number Page Number .-3 0-`nnI -- \ -° L -- 3cD - CQ . DO4- o 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 Q 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 El No $ UWe certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Date (month day. year) •�___ - '� X g„...„,„„..-iut,_ ---..,1*,.,t, , a , ( - .� Address of Appli .n (number and street, city. state, and ZiP code) 10 a on L i C---R-k:21 -- ;\--R , Ik 0&-k-}i -Cidi- t J-1 • -1\`1 LeL°r Signature of Aut onzed Representative Date (month, day• year)Address of Authorized Representative (number and street, city, state, and ZIP code) Signature of County Auditor Date (month. day, year) \' 'Cr\ ''NCL-51._q a . SLD3t-4rALLiNOC i ( %)3 . ' l' - 2--. (g . RECEIVED DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer DEC 18 2025 Gibson County Auditor A