Age_Bartley%4
APPLICATION FOR SENIOR CITIZEN
. n= ? PROPERTY TAX BENEFITS
State Fwm <3708 (R9 i 408)
�` � � Presrnbed by Ihe Deoartmem ol Local Govem�:am Fir,ante
Information contained in this tlocument is CONFIDENTIAL Dursuant to IC 6-7.1-12-9 and IC 6-1.1-35-9.
iNSrRUCnoNS:
COUNTY TOWNSHIP � YEAR
� I
ile k
DEC 1 0 2008
To be frled in persm or 6y mail with the CounfyAuditw of fhe counry where fhe woperty is /ocatetl.
Filing Dates: 7) Reel Pioperfy: Dunng the twelve (12) months be/ore December 37 o7fhe year the tleauction is to be eft@cfive�. /�[!��
2) Mobile Hwnes assessed under IC 64.1-7 0� menufactured homes nof assessed as real property: Dunr�Hxplt�9{72J'p]onths
6e/ore March 37 o(fhe yearthe deduction is to be eHective. �l ��
GIBSON COUNTY AUDITOR
See ieverse side /a atltldional instn�dions end qualifications.
Type d benef.t reCUestetl (poe e t3+eck a0lhat epply)
�er 65 Deduction 6om Assessed Valuation �er 65 Circuit Breaker Credit
Name of appfrcanl (ownw a caRrdcf buye�
Is eoPlimM tha 'a legal or eawfab owneY! No, what is his/har exaa shara w inte 7 I( owned vntn mmeone other than spouse,
I(IQIfd�B "AIf1 W:IOT
Yes ❑ No
H name on record is 7ifteient Nan that of aod�w�l indiwie belvx
Nama af mitaG seller (app/lcanf must Aaw boon Guying m cm✓act at loast orro (i) yca�
Address N mntratl sellar (num0orarid strce7. ciry. s:aro. arM ZIP coda) Is the �ropatly in cuaslion:
� Real property � Mobile home QC 6-f4-�
Taxing distnct Key number / Lapal descriptim I RecoN number Paye rumber
- -i -o �3-oa
U ihe DropaM used e oaupiad o���y br Acsessed va�ue of the omoerty as of March t, curtant year (may rwt ucoctl 5182,a30
hislnar residence7 Wr O�er 65 tlotluUion. a 5160.000 fir the Ovar 65 Cirunt &eaker Cmtl�Q
Yes ❑ No ' 3 3
Was the ap0��165 yean o( ege w mwe on Oecember 31 W the year
Have you fJed tor any other dedudions? I If Ves. whal dedvcLOrs? :
� Yes � No
Have you filed for CeducUOns in any oihar county7 If Yes, wnat county?
� Yes ❑ No
UWe certify under penalty of perjury thal lhe above and foregoing information is We and correct and ihat the applicant was a residenl
of Indiana and owne� of the aforementioned property on March 1, 20 _
S'gnat e of a�pfranl Address of aoolicar,t (numDCr and sfinet, ci.y. sfaro. and LP mCe)
��/�� ! �O��J ' �P � �
$�gneture auU: ed entativa ACdrass of autiorizaC raorasentativa (nvmber antl s✓eef, ci:y, xate. and ZlP code)