HomeMy WebLinkAboutAge_Hartig"' APPLICATION FOR SENIOR CITIZEN
� PROPERTY TAX BENEFITS
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� � H�. � Prescnbed by �he Departmerrt ot Local Govemmetn Finance
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File Mark
Infwmation wntained in Nis dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.735-9. p+,
INSTRUCTIONS: v/� �
TobefiledinpersonorbymailwifhNeCounryAUditorolthewunrywherathepropeRyislocated. GIBSONCOUNTYAUDITOR
Filirq Dates: 1J Reel Property: Dunrrg the fweNe (72) months be7ora December 31 o/fhe year (he deduction is to be efrective.
2J Mobile Hanes essesse0 urMer IC 6-7.1-7 or manulactured homes rrof assessed es real property: Dunrg Ihe (weNe (72) monfhs
be/ore March 37 0/ fhe yeer Ne tleduction is to be eflective.
See reverse side /a atldifional lnsWCtions end pualificalions.
TYOe d banef.t reCUesied (dease rheck aH Naf apWy) -
� Over 65 Deduction 6om Assessed Valuation � Over 65 Circuit Breaker Credit
Nam aoP�wni(owTe/u'cu'RiactDuye�
Nd
b eo7�im he soie legal or equitaMe owne/! If No, wh his/�er eaaG shara or irite 7 If owned with someone other Ihan spouse,
intlipte wilh whom
❑ Yes ❑ No
M name an recrnd is diflereM Man ihat o( aDO�xanl indicale bebw
Name of mritrecl seller (appiwnt must here Goon buying on contlacf al least om (i) yea7
Pdtlress ot mntrad seDer (numbor aM straef, cify, 5fate, aM ZIP cotla) �9lhe p�OPehy in queslion:
�eal pmperty � Mobile home (IC 6-74-�
� Taxinp olslriG Key num6er / Legal dexription Recwd number Page number
�� . ���hY-:1�=3�3=0_0� l�80- �C
Is ihe WopeRy used and occupied pnmarily for � 0.ssessed value of Ihe propeM as of March 7, wrtem yaar (may rwf arcoatl af82,430
hivher reaWence? (o/ 0`er 65 tlotl�Cbn, or E760,000 /o� fha Ovor 65 Circvit &oaNer CretliQ
�Yes ❑ No
Was ihe aODbcem 65 years of aga or mo�e on DecemCer 31 dlhe year
Have you filed for any other tleduabna7 If 1§s, what deducUons7
�'Yes ❑ No �S,
Have yau (ded fw deEuctions in any dher cwmy? If 1§s, wnat counry?
� Yes � No
I/We certify under penalty of perjury that the above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature ol aDW��� Address of apDlicsm (number and streol. ciry, stab, a ZIP mdo)
� � ioa � /� ' �%� 5C8�
� igneture Uauth - ed rao�eaenWtiva PCdasa of aut�aizaE represaniative (nu andsLeot. ciy, state. and LP cade)