HomeMy WebLinkAboutAge_Howard' a APPLICATION FOR SENIOR CITIZEN
>,_�. = t PROPERTYTAX BENEFITS
, �� �' smc� Forr� aa�oa �as i s-oe�
� i.� PrasrlibadbythaDeparimeMOlLaalGOVemmertlFinance
IMwmatiom m�tainetl in t�is doaiment is CONFIDENTULL pursuant W IC 61.1-12-9 and IC G7.1-35-9.
�
h
�
m,Fyr:nc��.r.��
COUNTY TOWNSHIP YEAR
APR 1 6 2012
To be filed in person or by mail wifh fhe CountyAuddor of fhe oounty where fhe property is locafed.
c.�.
Filiiy Dates: 7) Real Pioperty: Dunng fhe tweNe (12) mwrfhs 6e/ore Oecember 31 0! the ysa� the deducfiar is fo 6e e(feclive.
2) Mo6ile Hwnes assessed underlC 6-7.1-7 0� manNacturetl hwnes irot assessed as real piopeAy: Dunrig Ihe tweNe 72 ths
before Marrh 37 0/ the year the tletluction is to be eflective. G I BSON COU NTY AU D ITO R
See reverse side fw adtldional insWc(ions and qualificatims.
Type ot banafi requested (please rheck a9 Nat appl�
�Over 65 Deduction 6om Assessed Valuation .� (Ner 65 Circuit Breaker Credif
Name of appGaM (mxrea n rontrac! b�yeQ
�Je�.ahG .�<�\�
Is applkaM tha sole legal or eqWtaWe ame(/ H No, what is hisRier ezad shara w intarest? H owned with somerne ather Ihan spouse,
i(Mi�te with whom
❑ Yes ❑ No
II name rn recwd is diRerent Ihan Nat of applifant, indicale bebw
Name ot mntraf2 se0er (appricanf must hare 6een 6uyirg m cantrad at Mast ono (iJ yaaQ
Address of mntra�f mAer (num6ef ami streel rify, slafe. ad LP wde) Is the Pmpeny in 9uesiion:
�fteal property � Mobile homa QC 674-�
Tazing district Key number / Lepal descnptian Record number Page number
a5t. � '/8-13 - vo 3 - 000, 339- " � ' �'
Lv Ihe ptoperty used aM occupietl primarily tor Assessed vatue o( lhe property az ot Mamh 7, cvrtem yaar (may nof esceod S1B2,430
hiahar resitlenm7 (or O�er 65 dedudnm. ar Sf60,000 for Ne Over 65 C"vctirt Bioalmr CretliQ
�'Ses ❑ No
Was the eppfirant 65 years o( age n�re on Oecember 31 af the year Appf�nfs dafe of binh (manfi, day,
Mave you Ned far any olher deduc0ons? If Ws, what dedud'ptis?
' Yes ❑ No /-�.5. {�1'!'f
Hava yw filed tor dedu�ons in any other cauMy? �( Yrs, wha� mY?
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signatura dappGca`n AdEress of applimnt (rn�mDrraM sbooL �: s+ab, a�M Z/P wde) �
ao s ,� . �es-� _ S-� ,�� � �
ign re of author¢eE reP���^'e Addrass of aulhor�d represantativa (nvnber aritl sfineL �+�Y. stafe. and LP co0e)
.
,.