HomeMy WebLinkAboutAge_CundiffAPPLICATION FOR SENIOR CITIZEN cou r wNS r I na
�= PROPERTY TAX BENEFITS ;
� � !S State Fortn 43708 (R9 / 9-08)
� ,•�• Presaibed by the DepaNmaM af Loral Govemmerit Finance
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Informatiom m�tained in this document is CONFlDENTIAL pursuant lo IC 61.1-12-9 and IC 61.135-9.
c.�.�wsraucnoNS:
To6efiletlinpersonorbymailwitfrfheCountyAUtlrlorol(hecountywherethepropertyislocatetl. GIBSONCOUNTYAUDITOR
Filing Dates: 7) Real Property: Dunng Iha hveNe (72) months 6e/ore December 31 07 the year the deduction is to be aflective.
2J Mobile Hwnes assessed urMer IC 67J-7 or manNactured homes rrot assessed as real propedy: Dunig the hveNe (12) monfhs
before March 31 0/ the year the detluc6on is to be ef/ective.
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See iaverse side for add"Aional insWdions arM qualdicetims
Typa d benefi �epuastatl ease rheck aB fhaf apply)
Over 65 Deduclion Gom Assessed Valuation Over 65 Circuil Breaker Credit
Named M(owrrororcmtractbuyo�
�/���'� � (..i 1-C/YQ. ,
U appl�(rt lhe sole lepal or aq�0ade owneR If No, what i er exaG share w iritera57 H amed with mmeone olher Ihan spouse,
inditate with whom
❑ Yes ❑ No
It rame on record is diHerant Ihan tlut of epp6cant, indirate bebw
Name of conlraG selter (applrcanf must hare 6een buyirg on <onfrdct at leasf orre (1J yearf
Adtlrass d wntratl seller (niunber arH sbae4 �: stafe, aM ZIP mde) Is the property in question:
Real pmperty � Mobile home (IC 67-1-n
Tazing dislnct Key number / Legal desuiplion Record number Page number
-!D/-D�o. 3�.3-a� �
Is Ihe pmparty usad enE pied primaAy for Assessed valua af the propery as oi Mamh 1. ryrtaM Year (may nof e+mod f7H2430
hWher residenw7 !or O�er 65 Oatluclion, a� 5160,000IOr ffw Oser 65 Circut BreakrlCretl�
❑ Yes ❑ No
Was tha appf�rit 65 years of age w mwe on December 31 of the year
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Have you fded tar any other ded�rbons7 1! Ves. whal Eaductions7
" / I
�Yes � No ys, s ��/f�
i i '
Have yau filetl for tleductions in any olher cauMy7 H Ves. wtiat coumy7
� Yes No
IIWe certify under penalty of perjury that �he above and foregoing infortnation is true and correct and lhat lhe applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20
Signature of appfram Pddress of aDD�nt (mmber arid sbeet, afy, sfafo. eiM ZIP wde)
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Signature o(auNOnzetl representative Atltlress of aWhorimd reprasentative (numbararrd sGOaf, city, state, and LPcode)