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,,i^`-""' + APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
- PROPERTY TAX BENEFITS
.. State Form 43708 (R19 / 7-25) CA-SO(N ' 0 Q
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'6,8-- Prescnbed by the Department of Local Government Finance
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. --
Type of Benefit Requested (Please chec II that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (ow r or contr 1 b er) Telephone Number m it Address
SVIcie, -finS - ( )Is Apt e 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 cod is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in C•m on Reside on the Property?
PI Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the ' ►-rty Under Recorded Contract
for at Least One(1)Year before Claimi • redit?
ICI Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is he operty in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
o 0 — SCk Y (N 26- 2‘ -- 0a-- 2x)11- Ooo . 0To— 0b1
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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 qualified for a homestead standard deduction for the individual's homestead property in the immediately II Yes 0 No
preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year?
,I
i
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due& Payable? II Yes ❑ No
$
Ii1Ne certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur 'cant Date (month, day, y
xAddr s,
o licant (number and street, ity, state, and ZIP code)
S- S 1 G - J A N 15 2026
2
Signature of Authorized Representative Date (month, day. year)
Address of Authorized Representative (number and street, city. state, and ZIP code) a. p‘1,64.)
GIBSON COUNTY AUDITOR
Signature of Co ty Aud �` `' ` Date (mo th, y,aiy, ear)
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DISTRIBUTION: Onuinal - County Auditor; File-Stamped Copy - Taxpayer