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„` "<<i. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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Y PROPERTY TAX BENEFITS
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, 11116, : State Form 43708 (R19 /7-25)
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Nis. , ‘CPrescribed by the Department of Local Government Finance �O`
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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 at apply) -
Over 65 Credit ver 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Ries ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
[arg. ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
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es El No
Address of Co tract Seller (number and street, city, state, and ZIP code) Is the Prop in Question:
F2*\--- ea! Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Description Record Number Page Number
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Did Applicant q for the homeste standard deduction in the preceding year(or was applicant married at the time of death to
a deceased spouse who qualified or a homestead standard deduction for the individual's homestead property in the immediately [I—Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
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I.NVe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature f Applicant Date (month. day, year)
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A es of A plicant (number and street. city, state, and ZIP code)
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day,of Authorized Representative Date (month, year)
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Address of Authorized Representative (number and street. city, state, and ZIP code) 1
Signature of County Auditor Date (month, day, year)
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J A N 0 8 2026
DISTRIBUTION: Onginal — County Auditor; File-Stamped Copy — Taxpayer
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GIBSON COUNTY AUDITOR