HomeMy WebLinkAboutAge_Agee�'°' APPLICATION FOR SENIOR CITIZEN
��r.,': , PROPERTYTAXBENEFITS
�..,! Sfate Fortn d3708 (R9 / 448)
�� Praunbed by Ihe DeDahmeril of Local Goeemmem Finance
C �
Informatbm m�GineC fn this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61.1-35-9.
C � TO IP � YEAR
MAI
File Mark
C.'J.n�
wSrRUCnOrvs: GIBSON COUNTY qUDITOR
To be filed in person or by mail wifh fhe CountyAuditw o/ the counry wAeie the property is loce(ed.
Filing Dates: 7) Reel Property: During the fwehre (72J mwrths belore Decem6er 37 ollhe year the deduction is fo be etTective.
2) Mobile Homes assessed urMer IC 67.1-7 or manulacfured homes rrot essessed as real pioperty: DuRng the MsNe (12) months
be/ae Ma�clt 37 0/ Ure year the deduction is to 6e eflecfive.
See reverse sde /a edddional insWClions aM quelifications.
Type d befref,t reauested Id eck a0 fhet aOCM
Over 65 Deduction hom Assessed Valuation
Nama of apo�M (owner d canbad DuyeQ
I5 applimtN lhe sde lepal
�es ❑ No
It rama on racord is diReraM Nan thal d epplicanl in�
dIS�IIC�
IsNe[
hisRtar
I( NQ. What is hisrtier azad share
musl here beon Duyiip m caY.rott at least orre (7J yoa�
m0er (numba aM sbaeG �y: atafe, aiW ZIP oode)
65 yearn of age w rtmre on
yean
Key
x I No
� �_,
tha year
� No
65 Circuit Breaker Credif
i somewe aher Ihan soouse.
whom
a D�oeM �n Questron:
� Real pmperty � Nlobile home (IC 6-iJ-�
Record number � Page num6er
- 36-ioo -oo�f di�-o a7
Adjusted gross ineome of appliwnt, spouse, and any
individuals sharing ownership (FOrOver 65 deduction, income
may not exceed 525,000; /or the Over 65 Circuit Bieaker Credit,
income may nof exceed 530,000 for individuals, or 540,000 for
manied couples).
Mava you filed Iw airy othar dad�cGw�s7
� Yes � No
Have yw: fiied tor deEunions in eny dhar cwMy7
❑ Yes ❑ No
FvSSessed value of Ihe proparty as of Mamli /, c
lo�Ovor 65 dodudion, or S 160.000 !or Ne Ovei
Applimn�'s d2iB Of
_
Source of Income
If Ws. what deduclians?
Ir 19s. what
nof erccetl5tB2,d30
r Credi�
� If filec by a survivinp, unmar.ied spouse,
what was lha spouse'S age at the tima
o�a��z
Artrounl oi Income
IS
IS
TOTAL I � 0.00
IIVJe certify under penalty of perjury that the above and foregoing information is trua and wnect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Address of aov�ipm (numba arM strool, ciry, sfaM, arM Z/P mde)
of aulhmized raDiasentelivaj \ I�4�%s of euthorizad represen�ative (numbaraM sLeet, ciry, sfate, antl ZlP coda)