HomeMy WebLinkAboutAge_NolcoxAPPLICATION FOR SENIOR CITIZEN
t. .^. � PROPERTY TAX BENEFITS
� � -' State Fortn 43708 (R919-OB)
Prescri6ad try Iha Deoartment ot Local Govemment Finance
Information containetl in this tloament is CONFIDENTIAL pursuaN to IC 6-1.1-12-9 and IC 6-1.1-35-9.
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COUNTY � TOWNSHIP � YEAR
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Fil �Mark�"�
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iNSrRUCnoNS: �EC 3 1 200B
To be filetl in persm or by mail with the County Auditw oI fhe munty where flie property is located. �
Filing Oetes: i) Real Property: Ounng the AveNe (72) monfhs belore December 31 0/ ihe year tbe deducfion is to 6e elfes�HV i.
2J Mobile Hwnes assessed untler IC 6-7. 7-7 or manWactured homes not assessed es real property: Dunnqlhe �e,.�Y.�nfhs
before MarGr 37 0! the year Ihe tletlucfion is (o be eNecfive. GIBSON COV�17Y
See reverse sitle !a atlddional insWdions and Qualifications. %� UDITOR
TYpa d benBf.i �epuBSfeE /(Waaso dieck a� Ihaf aPply)
Y�1 Over 65 Deduclion from Assessed Valuation �Over 65 Circuit Breaker Credit
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Neme of aDD�Ca�1(o�++a' w contracl bvyorJ �
C/��� f / � D�C�
U aD7�� sde lepal or eQuitaMe owneR 11 No. what u hisfier eaacl share or ir.�eras�7 II owned with so.�neor.a other thar. spcuse,
indimta wit� wbom
❑ Yes ❑ No
11 name ai txad is diflerant Vwn Nal of a0d�w�C indicata 6eb«
Name of coni�cl seller (epdicanf must haro bcen buying on conl2ct al loast orm (i) ycarj
Pddreaa W wntratl sellar (numDer aM sbeef, cily, sWM, and ZIP mdo) � is ihe o�oerty in Question:
� Real propery � Mobile home (IC 6-1-7-n
�' '� I KeY number! Lepa�e5cnotip�D G�/ ,� / I��umber Page r.umber
� G �j � (O �r/ '7`e7 `7"
Q �
U Ne pmpeM use0 and occuqe anly br Assessed value of the pmoerty as of MarC. 1, werert year (may not erccc05182,d30
hisiher reaidena7 or Ouer65 doauGim, w 5f60.0001orino Ovcr 65 Ci�cuil Breakoi CrtH��
❑ Yes ❑ No
Was lhe aoW��165 yean o( a6e o� mwe on December 31 0l t�e year
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Adjusted grose ineome of appliwnt, spouse, and any � Source oi income � Amount oi income
individuals sharing ownership (For Over 65 deduction, income rO Y� a�p 7 I 5 (] ��3
may not exceed 525,000; 7or fhe Over 65 Circuit Breaker Credit. �
income may not exceed 530,000 lor individuals, o� 540,000 for I I S
mamed couples).
ITOTAL I S 0.00
Mave you @ed Iw a�ry other deductions7 If Ves, wha� aeductions? '
� Yes � No
Heve you filed for CeEUC�ions in any oiF.er counryi If Yes. wr.al county?
❑ Yes ❑ No
I/VJe ceAify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident.
of Indiana and owner of the aforementioned property on March 1, 20 ,
Si nature d aDO�nt AOdrass ot aootimrt (number and shcci, ci,y, staro. antl ZIP cotle)
.. - ,i� �• a 3.2�/N D �d /�� y �f/ ��� t� Y?� �
gnature of eNhwizetl re�rasanta•' PGtlress of aulhorizeC reo.'esenW�ive (nvmberantl s:reel, ciry. Rafe, anC ZIP code)