HomeMy WebLinkAboutAge_Blair� APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
S �! • State Fwm <3708 (R9l 4O8)
PrescnbeE by ihe Dapanmenf of Local Govemment Finanta
In'ortnation [ontainetl in this document is CONFIDENTIAL pursuan� to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
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File Mark
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To6efiledinpersonorbymailwithfheCountyAUditoroffhecountywherefheproperryislocafed. GIBSONCOUl�TYAUDITOR
Filing Dates: 7) Real Property: Dunng fhe fweNe (72) marfhs belore December 31 of the year the deduction is to be eHectrvs.
2) Mobile Hwnes assessed urMer IC 64. 7-7 or manu/actured homes not assessed as real properfy: Dunng ffie twefve (12) monffis
before March 37 o/fhe yeer the deduc6on is fo 6e eNective.
See reverse side 7a atldifional instrudions arM qualifications.
Type ot benefl raduestetl (p/oase rhock a0 fhaf applyj
�Over 65 Deduction from Assessed Valualion � Over 65 Circuit Breaker Credit
Name of a m(onner or caRran WyarJ
�(jCi1J (i(�...C..(�/ .
Is appOmm Na sde legal or epuitaGe owne(! If No, what is hisiher eaact share w ir.terest? If owned vntn someana ol�er ISan soouse,
indiC2te with whom
Yes ❑ No
If name on �ewN is diflarent Uan ihat of aodican4 �Mitate babw
Name of conlad saAar (appFCant must havo Doon Euying m cm:ratt at least oia (f) yea�
Address of mntred seller (number anE sbeel, crty, sfalo. und ZIP wde) Is Ihe o�oerty in ouestion:
� Real property ❑ Mobile home QC 6-7-1-n
�' �+q ' I Key m�mCer / �agal tlescnption Record number Pace number
a,�%-�aJ a� -p5-3/ �OD -o00.���-ea 7
Is the Drooerry useC and occupeC onmany for asessed value of f`e oroperty as of March 1, curtenf year (may not erceed 51B2.aJp
Nslner residenca7 Por O�er 65 daduUion, w 5:60.000 (o/!ho Ovcr 65 Circuif &caker Cadi:)
�Yes ❑ No
Was the eoD�ken165 yaars of a6e or mwe on Decam6ar 31 of tie year
o�deatn7
/
Adjusted gross income of appliwnR spouse, and any � Source of Income � nmount ot Income
individuals sharing ownership (FOrOver 65 deduction, income I I S
may not axceed 525, 000; /or the Over 65 Circuit Breake� C�edit,
income may rrot exceed 530,000 tor indivrduals, or 540,000 (or I S
married couples).
ITOTALIS 0.00
Have you fileE for any Wher deducGOns7 If Yes, w�hat dedvctions?
Yes � No � s �
Have you filed lor Ceductions in any other cwnryi �7 Yes, wnat covnty?
❑ Yes ❑ No
I/VJe certity under penalty of perjury thal the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20
� Sgnelure of appl'rsM Address of aoolimnl (numberantl swol. ury. sfate, and ZIP cotle)
T�-�- - � �, ,� 3� � E � � ' >e s D � � � o
Signature d autAOnzed �eo�asentativa Hddress of authwizec reaasentativa (numboiarN s C c�ry, state. and ZIP code)