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""•4 APPLICATION FOR SENIOR CITIZEN r 1a 4 -- 1 Y TAX BENEFITS PROPERTY COUNTY TOWNSHIP YEAR
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State Form 43708 (R19 7-25
'•i• Prescnbed by the Department of Local Government Finance I__- ---Q1b45 -1 kV - L' ,.di 4610Q5 .
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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 the calendar year in
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
Ier 65 Credit ! • ger 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
with Joint Tenant or Tenant in Common, Indicate with Whom 1
lia<s *
❑No -- -----
If Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common eside 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 Claiming Cr it'?
t -APt es 0 No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Pro. 'y it Question
pp -eal Property ❑ Mobile Home (lc 6-1. 1-7)
Taxing Distnct Key Number / Legal Description Record Number Page Number
, .) 1. 4 •_.V. _ d14 ' l'1- Ot-iok - aco Q3- mat . -
Did Applicant • ' for the hom to standard deduction in the preceding year (or was applicant married at the time of death to
a deceased spouse who qualified or a homestead standard deduction for the individual's homestead property in the immediately Yes 0 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 Taxes are First Due 8 Payable es ❑ No
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (mo th, day, year)
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X 01044 . Jitriti-4/ _
Address of Applicant (number and street. city, state, a ZIP ode)
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Signature of Authorize Representative tate (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
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Signature of County Auditor
- Date (month, day, year)
. �1 - aL�JAN 1 4 2026
. 04. L__\..) Cdtel)
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DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer GIBSON COUNTY AUDITOR