Age_Johnson
aco .,"'4 APPLICATION FOR SENIOR CITIZEN LE'uLJiEcJ)ip YEAR
a' .� PROPERTY TAX BENEFITS ��
. ,. State Form 43708 (R19 /7-25) e)t-02_,)
,,,. Prescribed by the Department of Local Government Finance L- �1- 26 - _i- 1
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 44? a. ar.
GIBBON 1 ' `'
Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of th���7 7 J rAWEDROR
which the property faxes are first due and payable.
See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please check all that apply)
00ver 65 Credit Over 65 Circuit Breaker Credit I
rIs Appli nt the Sole Legal or Equitable Owner') If No. What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑No _
If Name on Record is Different than Applicant. Indicate Below Do AU Joint Tenants or Tenants in Common Reside on the Property?
VrYes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming redit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) I the roperty in Question.
Real Property ❑ Mobile Home (iC 6-1.1-7)
Taxin istnct Key Number/ Legal Description Record Number Page NumberO'r/144L) toltriA'ri ‘61
- • a - `f00 - o00 , 55 $- aAo
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 E1 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 Prior to the Year Taxes are First Due & Payable' 51 Yes 0 No
$
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month. day, year)
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ddress of plicant (number and street. . state, and ZiP code)
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Signature of Authorized Representative - Date (month. day. year)
Address of Authorized Representative (number and street. city, state. and ZIP code)
Signature of County Auditor — Date (month, day, year)
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- I— / 5-
DISTRIBUTION: Original - County Auditor; File-Stamped Copy — Taxpayer