HomeMy WebLinkAboutAge_Woolsey�' APPLICATION FOR SENI�$ �T�N� � couNn TOWNSHIP � re,nR
�..-. PROPERTYTAXBENEFIj�S'
, ` � '' State Fortn 437081R9 / 4-08) � �
� � PresaibeE by Ne Departmem of Local Govemmem F�ance �
� Infom�ation contained in this dowment is CONFIDENTIAtpfhs4laif!'t85t�=��12-9 and IC G7.135-9. F�Ie e k
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wsrnucnorus: �� JUN Z 2009
To be file0ln persm or by mail with Ure CourrtyAudita o! the county whe th ertRy is locafed.
Filing Dafes: f) Reel Property: Dunrg Ne fweN@�qdf���YD�{���Q3� o/fhe year fhe deducUon is to 6�a9�YRye�ctive.� ��/"
2J Mo6ile Homes essessed uMer IC 57.1-7 ormanWaclured hames rrof essessed as real property: DHRn � ��) months
6etae March 37 o/the yearUre deduction is ro be efiecWe. GIBSON COUNTY AUDITOR
SeererersesidelwedddionellnsLVUionseMqualificatians. �
Type M banef.t repueSeO (p1 e Mock e6 Nef epp�
' Over:65�Ded'ucUOn'�fro.
Name ot appliqm (wvnx a cmhacf Wye�
�n �d � �
b epplimrit the sde lapal or apuitaWe owne(!
� Yes ❑ No
I( name on recortl is diAararit ihan Iha� o( eDd'rcznl iMic
of mntraa setlar
Over 65 Circuit Breaker Credit
�o�nie�, �
If No, whal ia his/her ezad share or intarast?
buying m cmvact af least orie (f) yea�
�
ior and sbee4 �+Q'. steto, aM ZIP wda)
spouse,
G�oerty in Quesi'ron:
Real property � Mobile home (IC 6-1-1-�
disinp Key numher / Legal deunolion Record numbar
Xul-or� 6-ao-13-(ob-oo(. c�S (
�mpery used aM oauded primaAly br Assessed value ol lha prooerry as of March 1,
�(asidence7 �� Orer 65 deduction, a 5160 OOO lo/ Ne Ova
Yes ❑ No
e eOW�m 65 years of age w rtrore on Decambar 31 W the year Apo�
Adjusted gross ineome of applicant, epouse, and any
individuals sharing ownership (FOr Over 65 deduction, income
may not exceed 525.000; (or lhe Over 65 Circuit Breaker Credit,
irxome may rrot exceed 530, 000 for individuals, or 540, 000 for
married touples).
Mava you fikd for arry oiher deEuttione?
C� ❑ No
OeEuctions in any dher courrty?
❑ Yes ❑ No
It Yus, what
IIWe certi(y under penalty of pe�ury that the above and foregoing information is true and correcl and lhat lhe applicanf was a residenl
of Indiana and owner of Ihe aforementioned property on March 1, 20
o(appficam Pddrass of ap0��mm (nambw nntl sWOf, ciy, state, aiW Z/P mdo)
� ' !dG Yz�7ooS �U/�k���
of authorizetl repraser�ative - . Adtlrass of eNtrorized reo�esentaiive (numberaM sueot. ciry, sfafe, and
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