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Age_Gladish� . APPLICATION FOR SENIOR CITIZEN couNn � TOWNSHIV � venR , PROPERTY TAX BENEFITS � S-� r state Fortn a37081RS / 9�08) Prescnbed by the Deparimem of Local Govammem Firance ile ar Infortnatiom m�tainetl in this doaimeni is CONPIDENTIAL Dursuant fn IC 6-1.1-12-9 and IC 6-7.1-35-9. wsrRUCnorvs: DEC 1 S 2008 To 6e filedln persm or 6y mail wiN the CounryAuditor o/ the munty where the property is located. Filing Dates: i) Real PropeRy: Ounm� the tweNe (72) months be%re December 31 o/the year the deducfion is to be eHective /��� 2J Mo6ile Homes assessed untler IC 6-iJ-7 o�manNacfured homes not assessed as real pmperty: Dunng �1�rrertg�s �/ betore Marrh 37 o7the yearfhe detluction is to be ellective. GIBSON COUMTY AUOITOR See ieverse sitle fw edddional insNUdions and qualificalions. \ J oe of beneft �eCUaS (d�se rhock a➢that apply) Over 65 Deduction hom Assessed Valuation Over 65 Circ�it Breaker Credit ime at ap0liwnt (owner or cantracf Guyo� �^ � /� /� ♦ //�' {� � G7�- � / ' ' i_�JC�c�.�—� �� / aoo���1 the sde lepal or eQUitabla ownelt If Na, what is nislhar e.ad share or inte:est? IF owned with wmaor.e inCirata with whom � Yes ❑ No H nama on record is barow satler (apd��anf masf I�aw Ocen Guyirg w: cmc2ct a: bast orro (i) ycar7 PAdress of mntraG seller (number aM sbeet, crty, state. aM ZIP code) Is Lhe proOeM usad a'W hislnarrB9iOenm7 IKe numSer l �e ��-/a� br �Yes ❑ No Was the appliaM 65 yean of age w mora on December 31 of iha year wior to Ne aireer�t yea(! �/ IXI Yes � No �--- Adjusted gross income of applicanf, spouse, and any individuals sharing ownership (ForOver 65 deduction, income may not exceed 525,000; /or fhe Over 65 Circuit Breaker Credit, income may not exceed 530,000 for individuals, or 540,000 fo� manied couples). Mava you filed (w arry Wher tleCUCtions7 filed lor deductions in any � Yes � No ? � Yes �No ine omoerty SOOUSe, IReal propery � Mobile home QC 6-7-7-n ' /,�O•��nROr�u/m/o)er Pa9er.uRber �/�l al / Assessed vatue ot tne oropetly as of March 1, curtar,l year (may wf exceetl 5182.a30 lor O�mr 65 dodunion, w 5160.000 Ior tho Ovcr 65 Circtnt &eaker Crod�� � � � I/VJe certify under penalty of perjury lhat the above and foregoing information is We and correct and that the applicanl was a resiaenl of Indiana and owner of the atorementioned property on March 1, 20 : Sgnatureo(zDd� lwdrassofaoo���i (nom6erand5nee4ci,y.s;ato,aMZIPCOCe) ' � ` �Gt, � /b u� c .3SO r �/K�✓��% � � Signalura of authonzed raoresentative ACdress of euthwizad rea�esentalive (r.umboraM s✓eel, ciry, stat , and LP