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SN` .T.'•a APPLICATION FOR SENIOR CITIZEN
�+ P YEAR
=! , PROPERTY TAX BENEFITSiii
,,, State Form 43708 (R19 /7-25) q 2
Nita Prescnbed by the Department of Local Government Finance - Q v n
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DEC 2 9 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 tti n y
which the property taxes are first due andpayable. "
p p y GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
al5"ver 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (ow or contract buyer)
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
171 Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Co m• Reside on the Property?
It Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the P .._ Under Recorded Contract
for at Least One(1)Year before Claim, • $ -.it?
N Yes ❑ No
Address of Contract Seller (number and street, city. state, and ZIP code) Is the Property in Question:
eel Property ❑ Mobile Home (IC 6.1.1-7)
Taxin District Key Number I Legal Description Record Number Page Number
d• 6 - 13 -31 - koo - oa °A 1-0/ 4 - 404, q
f .
Did Applicant qualify for the homes ad 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? es ❑ No
)(Signet e of Applicant Date (month. day, year)
• .iress if Applic nt (number and street, city, state, and ZIP code)
3?.)s3 S &sli F- taro i0\sc.. -3:2K) 41 W9
Signature of Authorized 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)
7
, )44-,--(J IA) 1 ,21 ., 9 ot S
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer