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�,` RAr,q, APPLICATION FOR SENIOR CITIZEN
d COUN Tog YEAR
:'' TAX BENEFITS r
s. � PROPERTY
[ _ ___State Form 43708 (R19 17-25) I` ` I • , 7432,
,,
'•,• Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. JAN 1 4 2026
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 yaf rn �,� i
which the property taxes are first due and payable. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please check all that apply)
,er 65 Credit er 65 Circuit Breaker Credit
Name of Applicant (owner contract buyer) r
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
EYes ❑No i -
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
D Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claim Cr it's
es ❑ No
Address of Contract Seller (number and street, city, state, and ZiP code) Is the Pr.perty in Question
IV 'ea' Property ❑ Mobile Home (IC 6-1.1-7)
Taxing Distnct Key Number 1 Legal Description Record Number Page Number
06,4A4' d 6 r O, - 7 -� �'DV D0 0, f0 6 • - 0 / 7 --
Did Applicant qual y 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 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? Yes ❑ No
$
IiWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signs ure of Applica Date (month. day, year)
4_/4A.1.4t746
4........41. 722 A_ .., 1" .:01
Address of Applicant (number and street. city. state, art"• ' c.•e
d; rot- Rot- , - --
Signature of Authorized Representative Date (month. day,HaAide.7_71. , \.,9eyt , 4/ 7fyo
Address of thonzed pese/(tative (number and street. city, state. and ZIP code)
Signature of County Auditor Date (month, day, year)
..1/14:- i I$01Z--(/)t-a_____44 ____ 1 '- / L-I ; ko
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer C\--