HomeMy WebLinkAboutAge_Garrett (2)�
APPLICATION FOR SENIOR CITIZEN
;..-. = PROPERTY TAX BENEFITS
` � ' f• State Fortn 43708 (R9I408)
PrascAbed try ihe Departmen� ol Local Govemment Financa
Information oontained in this document is CONFIDENTIAL pursuant to IC 6-1.'i-12-9 and IC 6-1.735-9.
���t�i:�y^1��,
.
, ;�.
; �
� Ai %i
INSTRUCTIONS: �6� ��
TobefiledinpersonorbymailwRhtheCountyAUdifwolthecountywherethepropertyislocated. GIBSONCOUtdTYAl1DITOR
Filing Dafes: iJ Real PropeRy: Dunng fhe hveNe (12) months 6e/ore Dewmber 37 0l the year the deduction is fo be eflective.
2J Mobile Homes assessed untler IC 6-1. 7-7 or manNactured homes not assessed as real property: Dunng fhe twsNe (72) months
be(ore Mart� 37 0/ the year fhe deduclion is fo be eHective.
See reverse side fw adddionel lnsWGions arM qualifications.
Typa d beneft repueSeE (p/oaso diack a0 Net epp�
Over 65 Deduction hom Assessed Valuation
IsaOOlime�the5olelegalorepuitaM�owneR IfNO,whaflfhis�Terezaclsha:e
❑ Yes ❑ No
H name on raco�d is Oiflarent L�an ihal of aod'�n� iMiwte babw
Name ot cont2e seiler (applicent musl haw Ooon buyirg on cont�acf at bast one (1) yea�
sbcet cr(y. stato. and ZIP ro0e)
3nd OCCUpieQ�dmdrily lat
Over 65 Circuit Breaker Credit
Key number / Legal dascnolion
'� - ii-l9 - aoo�oo.�
� Yes ❑ No
��an of age w more an Oecambe 31 d tne year
�Yes ❑ No
Adjusted grosa ineome of appliwnt, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
maynot exceed 525,000; lorthe Over65 Circuit 82akerCredit,
income may not exceed 530,000 lor individuals, or 540,000 fw
manied couples).
Hava you filed for erry other deductionsT
� YES
Hava you fled tw EeEuctions in any dher counry7'
� No
� Yes ❑ No
�� somaone otner ihan s0a:sa,
N^.OT
IS �OB DfO0Bf1)' i0 QUBSIi00:
�Real prope ,ry � Mobile home QC 6-14-�
� Racortl number Page number
Assessed valua of Ihe orooeny as of Mamh 1, cunent year (may not excvetl Sf B2,a30
:ar Ovcr 65 tloduction, w 5160.000 lor No Ovor 65 Circuil Broakor Crodif)
A�olicar.fs date of birth (mon:h, Eay. yoar) I( flea 5y a surviving. unmamed soouse,
na1 was Ihe spoase's age a1 ihe time
IS ���a3
�S
If Ves, wnal deducfior.s?
!� �
If Yes, wnat counry?
TOTALIS 0.00
IIVJe certify under penalty of perjury that the above and foregoing information is true and correct and thai the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
ot aoPlifar.t (numbe�and sVCet, ci.y, slate, antl ZIP codo)
'�/I�' n� i
y-y! ,✓��/ �08o S- o/� S2 �5 �Ll,ensv, l�s ,�
Sipnature of auUOAZeC rapresentaWa AdCress of authorizec reo:esentative (numbcr arW s;2et nry. sfato, and ZIP cotlo) ,