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Age_Mounts� "' APPLICATION FOR SENIOR CITIZEN couNrr TOWNSHIP reaR .,..-. ; PROPERTY TAX BENEFITS Sfate Fwm 43708 (R9 / 9-0e) •� � Prasmibed by Ne Departmenl o( Lod Govemmam Finance � ,•,• e a Informatiom m�tained in ihis doaiment is CONFIDEMIAL pursuant to IC G7.1-12-9 and IC 61.1-35-9. INSTf2UCTIONS: Tobefiletlinpersonorbymailwi(htheCountyAud�toro7fhe�untywherefhepropertyislocated. MAR 2� Z��2 Filing Dafes: 1) Real Pioperty: Ounng fhe fweNe (72) months belore December 31 0l the year the deduction irs- t�o^be eflecfive. 2) Mobi(e Hanes assessed u�er IC 6-7. 7-7 or manu/actured homes rrot assessed as real pmp8rty"��he (72) months be/ae Maiclt 37 of Ihe year the deduction is to be eReGive. v SeerevarsesidetoradditionalinsLudionsaiMqualifications. GIBSON COUNTY AUDITOR � �� TYPa of be�ft requested (ploase Meck a0 fhal aPWY) � Over 65 Deduclion from Assessed Valuation � Wer 65 Circuit Breaker Credil Name of ap (awner or wrtracf bu}c� Is appGrant tha sde lagal equitabla owneR N Nq what is is/her ezad share or inlarest? H ownetl with someane olhar than spousa, inditate with whom � Yes ❑ Na If name on recoN is difterent Ihan that of applicant, indicate heb.v Name o( mfirad selier (a nf musf have been buying m cantacf at lea5 orre (i) yeaQ Q AdCress at mntraa saAer (mmber ard sbeeG �A: state. aM LP code) Is ihe pioPeNY in question: �Real property � Mobile homa QC &14-� Tazing d' J�j Key num5er / Lapal desuiP�ion Record number PaBe number I /M1D �. Cl � ��! L%—�'O� 'D��•/ev7— /p Is �he ptoperty used and occupied prirtianly br Assessed value ot lhe pmperry as ot March 7, curtent year (may rrot exceed S1B2,430 hivher rasidence? IorO�er 65 Cetludim, or 5760,000 (o�Ne Ovei 65 Circ�ul Brealmr CreCi� � Yes ❑ No Was ihe app6dM 65 years ot apa or maa on December 31 0( Iha year Have you fileE tv any m�er detluctions7 If 1§s, what ded�ctions7 � Yes ❑ No Hava yw fJetl (or tleductions in any other counry7 If Ms, what muntyt ❑ Yes No IIVJe ceAify under penalty of perjury that the above and foregoing information is true and correct and that ihe applicant was a residenl of Indiana and owner of the aforementioned property on March 1, 20 Signatura dapd�M P.ddrass ot applimnt (numberan0 stroaf, dty, sfafe, aiH ZIP wde) �v , o SignaturedauUion�eEreprase 'e Pdtlressafauthorizedrepeesentative(numborarMSfrtwt,cify,sfafa,endTJPmtla)