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ct--:ai `'"ga APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP } YEAR
PROPERTY TAX BENEFITS
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State Form 43708 f R 19 / 7-251 501 i r,�L QcS •
rnment Finance a•
Prescribed by the Department of Local Government
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
1 Type of Benefit Requested (Please check a that apply)
Over 65 Credit 1=14;er 65 Circuit Breaker Credit -
I Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant in Common. Indicate with Whom
� Is AppOcaSole Legal or Equitable Owner,
i
es ❑No -- - —�
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Comm Reside on the-
Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property r Recorded Contract
for at Least One(1)Year before Claiming it?
Yes ❑ No
Address of Contract Seller (number and street, city. state. and ZIP code) Is the Prop rty in Question;
1 eal Priaerty ❑ Mobi{e Home (1C 6-1.1-7)
Taxing Distnct Key Number/Legal Descnption Record Number Page Number
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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 qua Iified for a homestead standard deduction for the individual's homestead p►operty 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 Poor to the Year Taxes are First Due & Payable? 1 j es ElNo
$
IfWe certify under penalty of perjury that the above and foregoing information is true and correct.
Si. . o•f Applicant Date (month. day, year)
-ss of Applica t (number and street. city, state. and ZX____7- 1: ,
�de). U . A‘ 4ar A,
*% % -co Date front . day. year)
Signature of Authorized Representative
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Address of Authorized Representative (number and street. city, state, and ZIP code) FILED
__ _ ___
_.._ .
____
Signature of County Auditor Date (month, day, year)
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DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer GIBSON COUNTY AUDITOR