HomeMy WebLinkAboutAge_Heldt�"' � APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR
;.-. ` PROPERTYTAXBENEFITS I
, -' State Fwm d37081� I 9-08)
Prasaibed by the DeDartmant of Local Govemmem Financa
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�j , � � e Mar� �
Informatioo mn;ainetl in this doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. g y eJ
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INSTRUCTIONS:
To 6e filed in person or by mail with the GountyAuditor o7 tha muhy where the properry is located. � E C 1 2 2 Q 0$
Filing Dales: 7) Real PropeRy: Dunng the tweNe (72) months be/ore December 37 olfhe ysar fhe detluclion is lo be eRecfive.
2J Mobile Hanes assessed under IC 6-1.1-7 ormanulactured homes rrot assessed as real pmperfy.' Dunng�Nyey�tweNe (72) monms
be/ae Mardr 37 0! the year fhe detluclion is to be eNecWe. p'! ���
See reverse sMe 7a atltltional instrudions arM quelifications.
GIBSON CO �� r
Typa of beneft raGUesteC (plea5e rheck aA Nat apyy�
�r 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name of apolicaM (owrrei d cmtracf OuyoQ
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Is aoo��m ine soia legal or eqvitaCie owneR If No. what is nisRier exad share or interes�? If ownad with somaone othe� than soouse.
indifala wilh whom
� Yes ❑ No
tl name on recortl is CifFeren� Nan ihat at aoo��can4 inCiwte bebw �
Name ot m2ct saller (applicanf musf Aave been Euyiig on con.2c1 af loast orro (1) ycarj
Address o ntrae seliar (numEeraM sbcet, crty, stare. arid Z/P cotle) is the omoerty in cuestion:
� Real propery � Mobile home (IC 644-�
Taving distncl_ Key num5er / Legal dewnolion Record numSer PaSa r.u:r.ber
a�-�q a4-��-�o.� ,
Is ihe wooerty useC and occupiad arJy br I 0.ssessed vaNe of t"e properry as o( March M1, wRent year (may rwt erceed Sl&2.<30
his�her rasideno7 (or O�er 65 dod�dion, w 5:60.000 !or Ihe Over 65 C'vc�if &aake� Credi:)
es ❑ No
Was iF,e aod�r 65 years of age w more on Decamber 31 of the year
� Amoum ot income �
individualssharingownership(ForOver65deduction,income n ^�,,, IS I�$�� I
may not exceed b25,000: for the Over 65 Circuit 8reaker Credit, �1 YM1y
income may rrot exceed 530,000 (or individuals, or 540.000 (or I I S I
manied couples).
TOTAL I S 0.00 I
Have yau (Jed for any other daductions7 If Yes, wnat deductior.s9
� ' s ❑ No � I
Have }rou FJeE for tleductions in any other wunry7 If Yes, wnal wunty?
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I/We certify under penalty of perjury lhat 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 7, 20 _
Signatureotap�li�nt MtlressofaoPlicant (numEarantlsbceGary.sfaro.antlZlPwtle)
° � ` 90 6 _ ioo � �
Signature of authwized reorase ativa Address of authorized reoasenWlive (numDCr antl sbcef, city, stalo, and ZIP catlo)
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