Age_Sloan Q4": 4 APPLICATION FOR SENIOR CITIZEN e 'co %T'� TQWNS _ra
PROPERTY TAX BENEFITS a y ;.r
S .. ! State Form 43708(R9/9-08) r))\x
® u.. Prescribed by the Department of Local Government Finance - �:!
fir �1w File ark
Information contained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. 7770a. q
INSTRUCTIONS: N
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To be riled in person or by mail with the County Auditor of the county where the property is located. GIBSON COUNTY AUDITOR
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)mrinths
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please Bieck all that apply) �„5y
❑ Over 65 Deduction from Assessed Valuation -4.•. Overd65'Ci[cuiN6(ea kerl6r ed-_.ti
Name of applicant(owner or contract buyer) /�/
4NtA ' 1
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes El No
It name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contact seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-7-7-7)
• Taxing distract Key number!Legal description I Record number Page number
L as -/3 -x9 -too -000. ? 89-0oV
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182.430
his/her residence? for Over 65 deduction,or 5160.000 for the Ovor 65 Circuit Breaker Credit)
Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you fled for any other deductions? It Yes,what deductions?
❑ Yes ❑ No
Have you fled for deductions in any other county? If Yes,wnat county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 .
XSignature of apglican dress of applicant (number and street,city state and ZIP code)
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® Signet re of authorized re resentative Address of authorized representative (number and street,ci(y.state,and ZIP code)
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DEC 1 0 "1_____ _008 _
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