HomeMy WebLinkAboutAge_Wright (3)APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS �
` '' Sfate Form 63708 (R9 / 9-08)
� �, Prescribad by �he Deoa+tmerrt ot Loral Govemment Finarxe
Informatbn contained in this tloamenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC G1.7-35-9.
INSTRUCTIONS:
COUNTY TOWNSHIP � YEAR
JUN 9 Z���
To be filetl in persm or 6y mail wNh the CourrtyAUtlita o/ Ne wunry wheie fhe property is locafad.
Filirg Dates: f J Real Pioperfy: Dunrg the tweNe (72) maRhs 6efae December 37 of the ysar the tleduclion is to ���p}re�Q
2J Mobile Hames assessed uMei IC 61.1-7 or manulectured homes rrot assessed es real property: Dunrn� fbH twa 121 mmths
belae March 37 o(the year the deduction is to be ellecWe. GIBSON COUNTY A 61TOH
See reverse side la adtldional (nsUVCtions and qualificetions. .
Typa of 6eireN re0ueste0lW eck e0 Nat applYl
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name d a0di�arit (rn.+� a' ca�bxl DyeQ
� •
Is eoolipM �he sole lepal or eQUitaWe ameR If No, what is hisRiar exad ahare w inte s � It owned with someone o�her Ihan spouse,
intlifate wit� whom
❑ Yes ❑ No
M name on racoM is difturem Nen Nat af aooGcant ��icate bebw
Name d wrtrzd seAer (apdicant mvst nave been ouyirg on cmtfacr at Mast orre (t) ym�
Pdtlress W mntratl seller (numbw arM sbeet crly. sble, eiM ZIP co0e) is the o�ocerty in Question:
� Real property � Mobile home (IC 6-7-7-�
� Tazing dislnd Key numher I Legal Eescnption RecoM numbar Page num�er
b- I-D -�o-t�v3• 636-
b tne oroveM used ana occuwee primariy tor AssasseE value of ihe property es of March 1, wnenl year (may rrot erttrod 518� d30
�ia�har rasidenw7 !or Orer 65 detludian, w f 160.000 /o/ Na Over 65 Ciicuif &eake� Crea��
eS O
VJas tha eoo�M 65 yean of ape or more on Decem7er 3 the year
Amourrt ot Income
individuals sharing ownership (FOrOver 65 deduction, income ¢� 'i 1�
may not exceed 525,000; /or the Ovar 65 Ci/cuif Breaker Credit, ��•
income may rrot exceed $30, 000 tor individuals, or 540.000 /or g
married couples).
TOTAL 5 0.00
Have yau (ded for a.ry dhar detluctionsT II Yas, v.�hat deductions?
� Yes � No
Mave you filed for deductiona in eny other counry7 11 Yes, wha� wunry?
� Yes � No
INJe certify under penalty of pe��ry that the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
$gnetura af appfrar� , MOrass of apP��mnt (number and sboof, city, sWfe, and Z/P wde)
� 4'16� S#R� 4 �Tir� �u 26
Spn ture auNOnzeC rep emative Pddrass of autnor'rzad reo�senta�iva (numDaraM svect. ciry, safo. and LP code)