Age_HarpeAPPLICATION FOR SENIOR CITIZEN couNrr TOWNSHIP venR
�. PROPERTY TAX BENEFITS �
` —' Staro Form 437081R9 / B-08�
��. P(esaibed by Me DepartmeM of local Govemmem Finance -� ��1
�le ark
Infwmation wntained in this docvment is CONFIDENTIAL pursuaN to �C 61.1-12-9 and IC 61.1-3 � 9. �
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INS7RUCTIONS: 1U�O
To be filetl !n person or by mail with tlre CountyAudita o7 the wun y where fhe property is locafed. � E L 1 4
Filirig Detes: i) Reel Property: Dunng the tweNe (72) months befo�e Decem6er 37 of the year the deUuction is to be eHective.
2) Mobde Homes assessed under IC 67.7-7 ormanufectured homes rrot assessed as reai'p{qpe D��tqe tweNe (12) months
bekve Mart� 37 0/ the year the deduction is to be eflecfive.
V,� :
Seeieversesidefora0tldionallnsWClionsandqualifications. GIBSON COUNTY U ITOR
Type M beneft repuesteO (plense Meck a0 Nat appl}�
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Nama of apo��M /� cantieCf OuyeQ
t9 BDO��C3ni Lhe sole IBpal or eQUitable ame(7 If No. what u hivher exad share w intaresl7 If owned with somaone olher Ihan spouse.
� indimta with whom
Q'Yes ❑ No
It neme on rewrd is dilfe�eM Man Na� d appfirant, indicata belo«
Name ot cont2d seller (applica f must have been btry'ug on cmUad af /east orre (1) yoeh
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Pddress W cont2ct setler (num or aH abee4 �j: sfafa, aM ZIP wtle) Is the v�oeM �n QuesYron: �
� Real property � Mobile home QC 64-7-�
Taxing Eisincl Key num6er / Legal description Record number Paga number
�- a�-i� i�3-3o3-000.s �a�
iz ma woaam �se� a�d xa,v�ea o��y ro� Asse55eE value of ttie property as ol March 1, curtent year (may imt orceeG 5182.630
hisRiar res'Wenca? h� Owr 65 tlotluUion, or Y 160.000 Ior Ne Ovcr 65 Circuit 8realw CreOi�
e5 o Na
Was 1t+e appl'�:�I65 yeare of ape or more on DecemCer 31 W the year
I
Have you filed (or a�ry Wher detluclionsT �t Ves, what deducaons7
L'� 'e' ❑ N� �
Have you filed for deductions in eny other courrtyl It 1gs, what cwnry?
� Yes No
IIVJe certify under penalty of perjury that the above and foregoing informa6o� is trve and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Sipnriure of aopfram Pdd�ass of applimnt (numOt4eM strea4 �rty. state, a�d Z/P wde)
�o-c,a. Q . �O o � E �►C.uo� � , rc.� �h-�Q � �.�
Sipnature o(authwaed ie0�asaritaUva Address ot authwixad reo�esantative (numbaraiM s✓oot. ciry, sfate, and Z/P coLO)