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Home My WebLink AboutAge_Burgess "' A APPLICATION FOR SENIOR CITIZEN co I. 1 NStIIP 'r YEAR •rt PROPERTY TAX BENEFITS S f State Form bed by the Department 408) all B 2 7 2014 by the Department of Local Government Finance 7), Fjle ark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. ,71'�Ilt INSTRUCTIONS: GIBSON COUNTY AUDITOR To be filed in person or by mail with the County Auditor of the county where the property is located. 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 61.1-7 or manufactured homes not assessed as real properly:During the twelve(12)months 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 check ail that apply) Over 65 Deduction from Assessed Valuation L�Over 65 Circuit Breaker Credit Nam of applicant(owner or contract buyer) ` - �.�/i/, c i O� ate • Is apprvant the sole legal or equitable owner? If No,what is his/her exact share or inte - If owned with someone other than spouse, indicate with whom ''Yes ❑ No If 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 contract seller(number and steer,city,stale,and ZIP code) 'Is the property in question: Real property ❑ Mobile home(IC 6-1-1-7) Taxing district Key number I Legal description Record number Page number / -7 , -//-1/- ao-Oa I-T. /VDo2/ Is the p rty us:. . ,d oroupiedl�' •.7112 Assessed value of the property as of March 1,current year(may not exceed$182,430 hisfner idenra for Over 65 deduction,or£160,000 for the Over 65 Circuit Breaker Credit) Yes ❑ No was the applicant 65 years of age or more on December 31 of the year / ❑ Yes ❑ No Have you fled for deductions in any other county? If'es,what 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 Signature of applicant Address of appmnt (number and street,city,state,and ZIP code) f IA-1 zufiny✓ G / ✓ it//D -S 40o la ou' wyuflie LA) I/ 766,E Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code) -� � � ❑ "' a APPLICATION FOR SENIOR CITIZEN : PROPERTY TAX BENEFITS Sqta Fortn 43708 (R9 / 9-OB) •� j P�ascnbed by Ne Dapanmefi of Lacal GovemmeM Fnanca Infortnation conGined in tha aoaiment is CONFIDENTIAL pursuant W IC 61.1-12-9 and IC 61.1-35-9. COUNTY TOWNSHIP YEAR Fle Mark INSTRUCTIONS: g� To be filed in person or 6y mail wi(h fhe CounfyAuditw of the munty whera the property is located. @ �� Filiry Dates: 7) Real Pioperty: Dunng fhe hveNe (72) mwdhs be/ae Decembe� 37 07 fhe year fhe deduction is to 6e �� 2) Mo6ile Hanes assessed under IC 67.7-7 0� manulacturetl homes nof assessetl as real pioperty.� Dunrg fhe Arslve (72) months 6e(ore Maidr 31 07 the yea� fhe tletluctron is to 6e eflec6've. See reverse side lw edddional insWdions and qualificatlms. FEB 2 7 2012 Type W banaf.t (e7uasted �Jease a0 fhat aPdY) �. J. �v '. — er 65 Deduction 6om Assessed Valuation er 65 Circuit Breaker C�c�d�ON COUNTY�r Name af apd�m (awno� o/ canha�� 6uyeQ . � � La appficam lha sde lepal or equtab' ownar! H No, what u hisRier exad shara w i(rterestT H xiN mmeana olher lhan spousa, i d la wiih whom Yes ❑ No It nama on recortl'a CiRerenl ihan Ihat af apd�nt, indkate bebw Nama of wntracl seller (appllcanf must hare been buying m contrdcf af /east orre (i) yoaQ Address d mntrart mller (num0er aM sbeeL �1: slate. aM ZIP mde) Is tha pmOeM in Cuestion: � Real pmperty � Mobile home (IC fii-7-n Taxing disLiG Key numbar / Lepal destnpl'pn Record number Paga number b - � - - UD - _5/, U tha propeM used arM occupieE primanly (or Assessed value of lhe proDefty as ot Maich i, ryneiri yaar (may not exceetl 2782,d30 his/her residanw9 � Orer 65 tleduCimy � 5160,000 Iur Ne Ovel65 Cirnnt &ealsrCmdi� ❑ Yes ❑ No Waa Ne appGraM 65 years o( age v mara on Oecembar 31 af the year rw.�a yG, r�ed ror em anar dad�n u r�. �� aad�mo�? � Yes ❑ No Have you fded tn tletluctions in any dher wunry? II kes, what couMy7 ❑ Yes ❑ No IIVJe certify under penalty of peryury thal the above and foregoing information is We and correct and that the applicant was a resident of Indiana and owner of the aforementioned property on March 1, 20 Signature d appGcant Ptldrass of appGmnt (numbera�d 56oe4 dry, sbb, aMZlPrudo) - - • , � Signature W euthonzed representative Mdress of authorimtl mpre�ntativa (numberarN sfroef, city, stafn, and LPcode)