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-1'-'----17'*4, APPLICATION FOR SENIOR CITIZENdr ., COUNTY TOWNSHIP YEAR
4 •`'1\ PROPERTY TAX BENEFITS
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State Form 43708 (R19 /7-25)
'°i! Prescribed by the Department of Local Government Finance Gson 028 2025
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 t year ' 1
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. pk ..._.
Type of Benefit Requested (Please check all that apply)
❑✓ Over 65 Credit YrJ."\-- 104. Q Over 65 Circuit BreDE r it0 2025
Name of Applicant (owner° Contract buyer) T one Number Email Address
Sink, Barbara Sa )
Is Applicant the Sole L I or Equitable Owner? If No, . A lic is E M.h o terest? If Owned with Join 1. Cb 4f '�Twith Whom
rEgVV 1-ergriui
AUDITOR
❑✓ Yes El No
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If Name on Record is Different than Applicant, Indicate Below U Do All Joint Tenants or Tenants in Common Reside on the Property?
DEC 3 n 2e�c ❑Yes ❑ No
Name of Contract Seller •J Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
.j,-" ❑ Yes ❑ No
Address of Contract Seller (number and street, city, state, ah fit,- - i Is the Property in Question:
GIBBON COUNTY AUDITOR ❑✓ Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number /Legal Description Record Number Page Number
028 26-11 -01 -404-002.606-028
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?
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Signatu e of Applicant Date (month, day, year)
CC _ /Jt)i7i- , a 0.-) /-
Address of Applicant (number and street, city, state, and ZIP code)
561 W Warnock St, Pton, IN 47670
Signature of Authorized Representative Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signatu e of County A or __ \�1 Date (mo h, day, ear)
1 2° -
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer