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1,^` " APPLICATION FOR SENIOR CITIZ COUNTY TOWNSHIP YEAR
- ti PROPERTY TAX BENEFITS
, ,, State Form 43708 (R19 /7-25) J A' `N ,, I___,,o,
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,414 Prescnbed by the Department of Local Government Finance 0 2 2026
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 acyakiticty jA4gt
,4perty is located.
GIBSON COUNN AUDITOR
Filing Date: Form must be completed, signed, and filed with the county auditor
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Type of Benefit Requested (Please he all that apply) — -- -CtI
P I Over-65 Credit Over 65 Circuit Breaker Credit
Npa1 01\4 'e of Applicant (o, er or con •:ct .uyer) Telephone Number ail Address
► "4 (
Is Applicant • e al: Legal uitatge-bwnei. If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common. Indicate with Whom
rill Yes ❑ No
If Name on 'e•ord 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 Claimi g redit?
Yes ❑ No
Address of Contract Seller (number and street, city, state. and ZIP code) Is the roperty in Question.
Real Property ❑ Mobile Home (lC 6-1.1-7)
Taxing Di t Key Number / Legal Description Record Number Page Number
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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 `VA Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant r)
0110iAddress of Applicant (number and street, city, sta , an ZIP code) rlk 'eloial% . Date (moday, ye
2 .
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Signature of Authonzed Representative ) Date (month, day, year)
Address of Authonzed Representative (number and street, city, state, and ZIP code)
Signature of County Auditor Date (mont . day, yea
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DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer