Age_Hurst� "' APPLICATION FOR SENIOR CITIZEN couNrv TOWNSHIP
PROPERTY TAX BENEFITS
Staro Fortn 43708 (R9 / 9-08)
� i.i � Prasaihed by the Depamnenl at Loral Govemmem Finance
IMwmation contained in Mis tlowment is CONFIDEN7IAL pursuam to IC 6-1.1-72-9 antl IC 61.1-35-9. I1J p �le� �
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J1 1
INSTRUCTIONS:
To be filed !n persm or by mail with the CouMyAUditw ol the wun y where the properfy is locatetl. MAY 1 7 Z � � �
Filily Dates: 1 J Real P�operty: Dunrg the fweNe (72J morrths 6e/ore December 37 0/ the year the tleduction is fo 6e ef/ective.
2) Mobile Hames assessed under IC 67.7-7 or menulactured homes �rot assessed as real property: Du�}d'hc�(121 �nw�Nis
(\ �
before March 31 o/Ne year the tletluction is to 6e eHecWe. V��
See reverse side 7or additionel insUVdions eM qualificafions. GIBSON COUNTY AUDITOR
TYOe d berreN `eauesled (W eck a9 Nat appty)
�5 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name of apd� (�� a canhacf DuyeQ '
b aoo�mm Na sde lepal or equitabl e(I N0, what U hi5/he! BzeO 9�are or irMeras�'! H owned with someane U�er t�an spouse,
indinte with whom
es ❑ No
tt name on remrtl u Ciifarem ihan Ihat d eppliwnt ��dicete beb«
Name d wntaa seller (applicant must have beon Duy'up m cronhaa at besf orw (t) yea�
� Pddress ot mntratl sellar (numbor aM sbee(, cdy, sfete, arrd ZIP co0e) Is the o�oerry in Question:
� Real pmperty � Mobile home (IC 6-14-�
distnd Key numbeN Leqal descnp�ion Record number Page number
�O �
Is ihe O�DeM used end o�ed p manly br AssesseE value of the propefty as of Ma¢h 7, wrtem year (may rrof ercce0 SiB2,a30
his/ner residencel fiiO�er 65 tlotlucfian. or 5760.000 !o� Ne Ovor 65 Circ(m Broaker Gatllf)
Yes ❑ No
Was the eDW��165 years of age or mwe on DecemEar 3 e year
Have yw (Jed (or a�ry dher deducCOns7 �f Ws, what deductionsl
� Yas � NO
Have ya+ filed iw deductians in any other cauMy7 If Yes, what coumy?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is We and corzect and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 �
�$ignature� of Ja "�carit Addrass ot epPlifant (num6erentl straef, crty, sWte, ami ZIPcoEe)
' U F.ca . (o ��e.� �
ip ature of authonzed rapresentative � Addresa of eNhorize0 reprasenfalive (numberarN s✓eet ciry, state, antl LPcrodo)