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4. APPLICATION FOR SENIOR CITIZEN coo,'MI It TO ' '�, YEAR
;-11V PROPERTY TAX BENEFITS - ion
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Siste Form 43708{R19 / 7•25) r
nil. . Prescribed by the Department of Local Government Finance 4 f
information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. `VLQ
instructions: To be fied in person or by mail with the county audIlor of the county where the property is 1
� �
Filing Date- Form must be Completed, signed, and filed with the county auditor or postmarked by January
GI 15B o t'n� r
which the property taxes are first due and payable yA Lop_ R
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please chats plhat apply)
Over 65 Crediter 65 Circuit Breaker Credit ,
me of Appfcant(owner or contract buyer)
Owned Joint Tenant or Tenant in Common,Indicate with Whom
Lam] T Cs ❑No
If Name on Record is Different than Applicant, Indicate Bestow Oo All J nt Tenants or Tenants in Common Res de on the Property?
Dies El No
Name of Contract Seller Has Applicant Owned or Bought tthe Property Uodef Recorded Contract
for at Least One(1)Year before Clan it?
le Yes ❑ No
Address of Conirsct Seller (number and skeet. city, slate, and ZIP code) s the Property In Question: -Ellie- -
al Property ❑Mobile Home(iC 6-1.1-7)
Ta/xxiinA District Key Number/Legal Descriplio/� /I / +%'�/'// ////y /�/,/(j Record Number Page Number
Did Appl :qualify for the homestead standard deduction in the preceding year(or was applicant married et the lime of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately a es ❑ 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? (es t I ❑ NO
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature •dicant i ? ate (me h, day, year)
25
iii.
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Add res Applicant (number and steet city, state. and ZIP code)
Signature of Authorized Reptesertative Dale (month day.year)
Address of Authorized Representative (number end street. city, state, and ZiP code)
5' of County Auditori9_77/2„.
/f A Date th,day.year)
caLaze a •
•
ilde&cit /3 A ta;260.
FILED 0
DISTRIBUTION: Original — County Auditor; Filo-Stamped Copy— Taxpayer
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J A N 2 2 2026
(t.124 /211.4e (2. *14-ithth241)'
GIBSON COUNTY AUDITOR