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��` ""' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
:t 4 PROPERTY TAX BENEFITS
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,, State Form 43708 (R 19 /7-25) 3 '� OM
141,11 Prescnbed 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 marl 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
Type of Benefit Requested (Please check all that apply)
❑Over 65 Credit ❑ Over 65 Circuit Breaker Credit
me of Applicant (owner or contract buyer) Telephone Number Email Address
-\ -- aNA t_. S 4_0.1 . ( )
Is Applicant the L g r Equitable Owner? If No. What is Applicants Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common. Indicate with Whom
Yes ❑No _ I
If Name on ecor is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Co mon Reside on the Property?
j Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the r..• y Under Recorded Contract
for at Least One(1)Year before Claimin• r edit?
to Yes ❑ No
Address of Contract Seller (number and street. city, state, and ZIP code) Is the Property in Question
PAI eal Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number 1 Legal Description Record Number Page Number 1
_ CD1g 2C-\2- 18 2- obi . a.32 ^
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 E4 Yes El 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 Prior to the Year l axes are First Due & Payable? pi. es ❑ No
Signature of Appli>:nt Date (month, day, year)
4V4d 4 ,_ . 4 e..4�. / _ _ot , -- s ,__c1)-kdt-,s-\- JAN 1 2026
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Address of App scant (num.-r and street. city. state. and ZIP code)
Signature of Authorized Representative Date (m )
GIBSON COUNTY AUDITOR
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signature of Cou ty A ditor [oaton. 7ear)
V \\7)--e.., Co
1 1 i_. .7c°2- .
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer