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4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
-- I PROPERTY TAX BENEFITS
i, 'r� State Form 43708 (R19 / 7 25) C. ,1bs Oc\ FW--4 t\ C6th cY>
'ili0 Prescribed by the Department of Local Government Financey
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 properly taxes are first due and payable
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
ver 65 Credit ver 65 Circuit Breaker Credit -
Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant in Common. Indicate with Whom
D 'Yes ❑No
If Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Yes ❑ No
Name of Con act Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One (1)Year before Claiming Cred
el •
- - es _ ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Pro erty in Question.
Real Property El Mobile Home (1C 6-1 1-7)
Taxing District Key Number 1 Legal Description Record Number i Page Number
Pic\ c - c \ Q U " 1"a-(9-1- it) I -- 030'95 - O 2 .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 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? [11e5 0 No
$
IfWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of pplicant i Date (month, day, year)
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Address of Applicant (number and street ity, state, and ZiP code)
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Si 9 nature of Author zed Representative Da (month, day, year)
_ FILED
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor Date (month, day, year
CIII 2026
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GIBSON COUNTY AUDITOR
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer