Age_SpeedyAPPLICATION POR SENIOR CITIZEN
' PROPERTY TAX BENEFITS
`...'• SbreForma3708(R9/9-08) .
� Piascnbed by the Deoanma'rt of Local Govemmem Finance '
Infwmatiom m�tained in this tlocumenl is CONFIDENTIAL pursuan� to IC 6-1.1-12-9 and IC 6-1.i35-9.
TOWNSHIP YEAR
JelJ �
INSTRUCT10N5:
To be filed !n persar or by mail wifh the CountyAutlita o1 fhe wunty where Me property is located. � E C 2 9 1 �� �
Filing Dates: 7J Reel Pioperfy: Dunng the MreNe (72) monfhs 6e(ae Decem6er 37 07 the year fhe deducfion is to be eNective.
2) Mobile Hortres assessed u�er IC &7. 7-7 or manufactured hortres rrot assessed es real property: Dunry the hveNe (12) monlhs
aero.e Merrn 31 unne yea� fhe eeeuctio� rs fo ae e//ecWe. 41� G� P
See reverse side lar adddionel insWGions eiM Qualfications. GIBSON COUNTY AUDITnR
TYOe d barreft reQUeded (P�ease M Naf aPPN)
er 65 Deduction from Assessed Valuation er 65 Circuii Breaker Credit
Nama of apDGcam
L
If No, whai u�sRier ezact stiare w
[�-� ❑ No �
«, rec«d'o d'dlerem me� u,z� or xoD�wnt ��alcate ta�o«
Name of contrad
ea� o� m cm;�a
stab. aM ZIP mEe)
(�l l'aa9
I with someona Whet than 5pouse,
wit� whom
� Real proparty � MoDile home (IC 6-1-f-�
Taxinq istrkt Kay num6er / legal tlascnption Racord number PaBe number
Q �-i a-1 o-I oo -od �.��-oa�
U 1he o�PeM used and occuped pAmariy for Assessed value o( lhe D�oPe�iy as ot Ma¢h 7, cunent year (may not axceed S1B2,130
hisfner rasiOencel lor O�er 65 detluCiun. a 5760.000 !or Ne Ova 65 Circtut &oakel Gedi�
� Yes ❑ No
N'as the aDM�am 65 yean oi e8e or more on December 31 d lhe year
prior to Na wrrerN yea/7
p-� ❑ No
Adjusted gross income of appliwnt, spouse, and any
individuals sharing ownership (ForOver 65 deducfion, income
may not exceed $25,000; (or the Over 65 Ciicuit Bieaker Credit,
income may not exceed $30,000 for individuals, or 540,000 /or
married touples).
Have you filed
otherdeEUCtions7
❑ Yes
Wher mur�y?
� Y85
No
INVe certify under penalty of perjury that the above and (oregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20 _
Signatura o1 appilcartl ACtlta58 of eDG���nt (numbaand sbcct, ciry, slate, arid Z/PCOdo)
_. ' � aya� F s� � P/��� 9� v7��v
� Ign^ otauthorize0 r�amaW Mdressofauihorizearepresentalive (numberaMSLOOt,ciry.stete.anEZlPcotle)