HomeMy WebLinkAboutAge_Smith� APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR i
. PROPERTY TAX BENEFITS
` ! Sfata Fortn 43708 (R9 / 408)
� � PrescAbed by the Daparimertl ol Local Govemment Fina�e
F' Mark
Infortnatiom m�tained in this doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61J35-
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�NSrRUCnoNS: MAY 4 2011
To 6e filed in persm or by mail with Ne CouMyAUd'Rw o/ the counry where fhe property is locafed.
Filing Detes: 7) Reel Property: Dunrg the tweNe /72) months 6efore Decem6er 31 0l the ysar the dedu t�io�;Vf�e
2J Moblle Hanes assessed urrder IC 6-1.1-7 or manu/actured homes rrot assessed as real p�operty: Du � �velve (72) monfhs
6e/ore March 31 0/ the yeer Ihe detluction is to be effective.
See reverse side Iw adOdional lnsLUUions arrd aualiAcations.
GIBSON COUNTY AUDITO
Type of beneft �uested (pleas eck a0lhat apply)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credif
Nameofapd�m a��Duye� �
�'
19 eDG�kan1 Ne sole lepal o� eQUilade eR If No, what is hiNher exact shara or imerex7 H owned wilh swneone dhar Ihan spouse,
in0iwte wilh whom
es ❑ No
If name on record is d'AfereM Ihan that of appli�an� iMicate below
Name of wrrt2d seAer (eppGCant musf hare Geon 0 yvp m cm72ct at basf one (1) yea7
Address W wntrad seller (numOm arid atreel, cily, sFeto, aM Z/P cotle) Is Ihe prooerry in puesiion:
� Real property ❑ Mobile home (IC 6-7-7-�
Taxirq distnd Kay numbar / Lepal descnolion Recwd numbar Paga mmher
- ^ - AO��'%aa�Ol
Is Ihe pfopeM used aM attupied primarJy br Assessad value ot the WoDeM as al Ma(ch 7, curtem year (may irot erceetl 5184,430
NNher'esidencel /or 0`er 65 tletluflian, ar f 160.000 hr Ne Over 65 Ciicuif &eakor CratliQ
Yes ❑ No
Waa the eppliram 65 yeara of aqe a more on December 31 of 1ha yaar
Have you filed for a.ry ofher de4uctionsl If Vus, whal dad�ctions?
� Yes ❑ No
Have you (JeO for deductions in any olher murrty? I�f 1§s, wha� counry?
❑ Yes ❑ No
IIWe ceRify under penalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a resident
of Indiana and owner of lhe atorementioned property on March 1, 20 .
SignaNra OGcer� Pdtlrass ot aOG��m�t (numDOrantl stroet. ciry, sfafo, aM Z/P coda)
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S natura of auLhorized raD�esentative ' Mdress of aulhorisd rao�esenia�rve (numDer aM sboo4 ciry, stafe, and LP code)