HomeMy WebLinkAboutAge_Feistel" APPLICATION FOR SENIOR CITIZEN CouNrv TOWNSHIP YEAR
PROPERTY TAX BENEFITS
'S '' • State Fortn 43708 (R9 / 408)
,.0 Prasaihed by Ihe Departmeert o( lacal Go�emmeM Finance
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IMormatiom m�tained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61.1-359.
INSTRUCTIONS: p
To be filetl in persm or by mail with fhe CountyAutlitor o/ fhe county where Ihe poperty is located. � U N 1 p 20 �2
Filing Dates: 1) Real Property: Dun� the twelve (12) months belore Decsmber 37 0l the year the tleduction is to 6e effective.
2) Mobile Hwnes assessed under IC 61.7-7 or manu/aclured homes irot assessed as real property: �urirr�Q����months
be/ore Mart,� 37 of the year the deduction is to be eflective.
Seereversesidelaredddionalinstiuctioruandqualifications GIBSON COUNTY AUDITOR
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TYPa ��nef.t reQuasted (ploase rheck aH Nat apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name d applimrt (wmer or contracl buyeh
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Is app M lhe mle lepal or equitada owne/! tt No, whai is hisRier exad share a interest? If owned wilh svmeona Mher ihan spoum,
inditate with wFwm
Y� o No
H name on record is diflerent Ihan that of apqiran� inCicate beb«
Name of mntratl se0er (appficanf mus( hare bern buying m cmfracf at kasf orre (1f yraQ
Pddresa ot mntratl mller (n�m6er aritl sbaeL �: sfale, aM LP mde) Is the pmperty in question:
Real pmperty � Mobile homa (!C 67-1-�
disl � Key number / Lepal tlescnplion Remrd num6er Page number
��� "`2 � 3- �=�o�-acb. Q' -�X�
Is Ihe p�operty useE aM xwpietl primardy for Assassed value ot the prope:ty az oi Marrh 7, wRaM year (may imf �moE 5782,430
his/nar residenml for O�er 65 Eeduclion, o-Ef60,000 Por fhe Uw 65 Circ�f Broaker CrediQ
❑ Yes ❑ No
Was iha eppGaM 65 years o( age w rtrore on December 31 ot ihe year
.�
Adjusted gross income of appliwnR spouse, and any Source of Income AmouM of Income
individuals sharing ownership (ForOver65 deduction, income $
may not exceed 525, 000; fo� fhe Over 65 Circuit 82aker Credit,
income may rat exceed 330,000 forindividuals, or 540,000 /or $
manied couples). �,�y
TOTAL $ �3 `�BB-
Have you (Jed far any othar deducOansT tl 74s, what deGuctions?
� Yes � No
Hava yw filed tor deduc6ons in any aher murityt If Yes, what m�nry7
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature ot appfirarit Atldress of applimrit (numOrlantlstroeL �+ty, state, arM ZlPOOde)
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Signature of aulhoAzed representative Address o(auUiorized representalive (numEerand sbeef, city, sfate, and LP cade)
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