Age_Witt�a�APPLICATION FOR SENIOR CITIZEN cour+n � TOWNSHIP venR
PROPERTY TAX BENEFITS
State Form d3708 (R9I408) �
� S,�i � Prescnbad by ihe DeDaM1ment of Lacal Govemmem Firance ,!i; w. �I
!'IIC fc
In`ormatiom m�tained in this tlocument is CONFIDENTIAL pursuaN to IC 6-1.1-12-9 and IC 6-1.1-35-9.
DEC 3 0 2008
INSTftUCT10NS:
To be filed in person or by mail wifh tAe CountyAUtlitor o/fhe county where the properry is located.
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Filing Dates: 7) Real Property: Dunng the hveNe (12J months belore December 37 o(the year fhe deduction is to be efle .a N f
2J Mobile Hwnes assessed urMer IL 6-7J-7 oi manulacturetl homes not assessed as real pmperty:GIBSON CO T Y�OR
be%re Marc� 37 o/lhe }rear the tleduc6�on is to be eflec6ve.
See reverse side7w edddional instmdions entl qualifica6ons.
Type d benafit reGUested (Woaso MockaA Nat app'y)
�Over 65 Deduction 6om Assessed ValuaGon �er 65 Circuit Breaker Credit
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Name af epdicar� /ownai � cmtract bu}oQ
Y � �
Is avpliprit the sde legal or eQurtaCia wmerl If No. what is nisfnar exact share w i:.te:esi? If owned vnth someone otner than spouse.
incirate vnth whom
� Yes ❑ No
H name on record is difterent Nan Mat of aod��l ��aicate hebw
Name af ca�irarl se0er (eyyicent musf nare beon Euyinp m convact at bast oire (ij yearj
Address of mntratl selier (num6aaM sbeo(, tily. stato, ari0 ZIP code) �s ina �moerry in ouestion:
� Real property � Mobile home QC 6-74-n
T�ing is ntl Key numSer / Lagal deunotion I RecoN numbar Page r.umber
�o�e.� � -/ -iy -/oo -oo3-/qG;-oa7
Is the O�Perry usaC ana occupied o�many br .4ssessec value o! Ihe o�ooerty as ol March 1, curter.t yaar (may nof oxccotl 57ffi.a30
his/ner rBaidenta7 (ar O�cr 65 dcductim. w 5160.000 (orfhc Ovcr 65 CiicuR &oJkc/ Lrodi�
� Yes ❑ No
VJas the aoWiwnt 65 yeare of age or mwe on Decembar 31 ot the year
Have you filed fw any other tletluctions? If �s. •xhat deduciions?
�,�5 ❑ No S
Have you fiied fw Eedudions in any othe� wuoryi If `es, wnaf counry?
� Yes ❑ No
INVe certify under penalty of perjury that the above and foregoing information is We and correct and that the applicant was a resident
of Indiana and ownar of lhe aforementioned property on March 1, 20 _
SgnaNre! apprranl Pddressofao�licar.t (num0erandsGCCl,ci.y,sta:e.aMZIPCOCe)
�� �, �� , �a s, �, �.,-� ��-� .�
� Sgnatureofauthorizedreoraseniativa Addeassafauthorizecreoresentative (numLerandstrtmt.ciry.stato.andZlPcade�