HomeMy WebLinkAboutAge_SharrettAPPLICATION FOR SENIOR CITIZEN couNn I TOWNSHIP � YEAR
;. .. _ PROPERTY TAX BENEFITS
S-�! • StatB Fortn 43708 (R9l 9-0B) '
� o, Prescribed Dy Na Oeoartmer.t ol Lo�'al Govemment Fi:.ance
Intormation containetl in this tlowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC 6-1.135-9.
iNSrRUCnoNS: DE� 3 1 2008
To bel/ed in person o�by mail witb Ihe CountyAudifor o/fhe counry where the property is located. �
Filirg Detes: 1� Real Property: Dunng fhe tweNe (72) months 6e(oie Decem6e� 31 01 the year fhe deducfion is to be eNe��� ��
2 Mo6ile Hanes assessed under IC 6-7. 7-7 or manu/actured homes nof essessed as real pmperty: Dunrrg e 6 (12J fhs
be/ae March 37 o7the yeer the deduc6on is ro 6e ei/ective. G�BSON COUh7Y AUDITO�
See reverse side /a etltldional InsWCtions arM qualificatlons.
Type d beneN'eGUeSeE (pleasa Mock a9 Nat appryj
1XI Over 65 Deduction from Assessed ValuaGon � Over 65 Circuit Breaker Credit
�
�
Name of epNirarrt (owbet a cpMrecf Duye�
Is apPliqfit t}fe�sW�'feyal ar eamtaMe owneR
% %
V ❑ Yes ❑ No
If name on rewrd is diflareM Uan ihal oi a�oficant im
Name ot
T��B
what is hislner ezact share or
have been buyirg on conLad at /ea4 orro (i) Yea�
cor.traC seller (number aiW sbeef, cM. s(alo, antl ZIP cotle) �
If owned vnth someor.e other than spc�se,
indimte with wham
Is ihe orooerty
Real property � Mobile home (/C 64-7-n
IKey num6er / lagal de5cn0�ion Record num6er Page number
�G-Os �a-/�-��• �a-��
and occu0i d o� ly br I 0.ssessed value of the pmoeny as o( Mamh 1, wereri year (may rrot erweG 5182.a30
(or Over 65 datludion, or 5160.000 lor+ho Ovor 65 Circuit Bmaker Cretlit)
❑ Yes ❑ No
Was ihe aOW��+165 yean of aga w mara on Oacember 31 ot tha yaar
o�or co the airram yea/!
� Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (ForOver 65 daduction, income
may not exceed 525, 000; fo� the Over 65 Circuit B�eaker Credif.
income may rrot exceed 530,000 for individuals. or 540.000 for
mamed couples).
Hava you (ied for ary Mher dedudions?
� Yes � No
Hava yov fled tw daCuctions in any other
❑ Yes
� No
I/We certify under penalty of perjury that the above and (oregoing informalion is We and correct and thal the applicant was a resident
Indiana and owner ot t� aforementioned property on March 7, 20 _ �
7nat re of aodkem / Address of apo�r.t (numDerar.ds a; n,y. aro. and I;P��tl�)
��7�� /%:� -`� '
�"' � � ��z�
nawre d a�thonz raoresentativa Pddress af aulhwizeC reaasen�ative (numGer antl Y.met, ciry, staee. antl LP code)