HomeMy WebLinkAboutAge_Wallace�APPLICATION FOR SENIOR CITIZEN
;. . PROPERTY TAX BENEFITS
�'• Sbte Form 43708 (R919-OB)
Prasai6ed by tha DeDartment of Lotal Govamment Financa
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Informatian containetl in this document is CONFIDENTIAL pursuant to IC 6-1.L12-9 and IC 6-1.135-9.
COUNTY I TOWNSHIP I YEAR
INSTRUCTIONS: L
To 6e filed in persm or 6y mail with the CounfyAuditor o! tha wunty where the property is locafed. �J C C 2 9 2 ��8
Filing Dates: 1� Real PropeRy: Dunng the hveNe (12J mmths 6e/ae Dewmber 31 of the year the deduction is to be eNective.
2) Mobde Homes assessed under IC 6-7J-7 ormanuledured homes rrof assessed as real property: Ou�/nryng the twe �2J monfns
be/ae March 37 0/ the year fhe detluctlon is to be eHec6ve. �"�a� �'
Seereve�sesitlelwadditionalins(rudionsaMpualificafions. GIBSON COUNTY AUDITOR
Type d beneft reduested (yea eck a➢ that app�y)
Ove� 65 Deduclion from Assessed Valuation ver 65 Circuit Breaker Credit
Nama of aoUicam
Is eoo��m tna sde
6vyo� _V —V^'
J �+c� � Y " , w l.-(�
� owneR It No, what is hisRier e>ad s�are
❑ Yes
If name on record is diRe�eni than Ihat
Name of mitad seller pd�antmu:
❑ No
Doon Dvyirg m cm[ract at leas( ono (f1 yoa�
W mntrad spller (num6eraM stroet, city. stalo, anC ZIP �de)
Key num6er / Legal descnption
�iL��✓�v�-�.
If axneE vnih somaone other than soouse.
indifate w�ih whom
Is tne om�erty
� R al property ❑ Mobile homa (IC 644-�
Record number ( Page r.umber
aG-��Y33 �zo-ct�,.oGt�-�z�'
Is Ihe O�ywM used and occupied o�many kr I hssessed value of ibe orooeny as ot Ma¢h 1, wnert year
hislner residemaT Por O�mr 65 deduGion. w 5 f 60.0001or t�o Ovcr 65 Circuit i
Yes ❑ No
Was the aoW�wM 65 }rears of aga w rtwre on December 31 of ine year
pnor to Ma arrer.t yea(!
Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sAaring ownership (ForOver 65 deduction, income
may not exceed 525,000; 7or the Ovar 65 Circuit Breaker Credit,
rncome may rrot exceed 530,000 !or individuals, or S40,000 for
married couples).
Have yw (lad for a.ry Wher Eeductions?
Have you filed fw CeducUons in
C�� O Na
� Yes No
/
IIWe certify under penalty of perjury that lhe above and foregoing information is We and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Sgnature d epplicant Address ot aoolinrt (number ar,tl svicel. ci,y, smro, and ZIP code)
o(auNwizeC reoresentative � Address of authorizec reorasentativa (nvmbeqBnE snoaf, ciry. state, antl