HomeMy WebLinkAboutAge_LameyAPPLICATION FOR SENIOR CITIZEN
� r,./.rt. � PROPERTY TAX BENEFITS
` I.'.' Stale Fwm a3708 (R9 / 9-OB) .
Piasuibed by the Deparhnerit of Local Govemmem Finance
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Infwmation wntainad in Ihis tlocument is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC G1.1-35-9.
iNSraucnoNS:
COUNTY TOWNSHIP � YEAR
Fi rk
MAY 0 5 2010
To be filed In persar o� by mail wHh the GountyAudifor o/ the wunty where the property is located.
Filirg Oates: 1) Real Pioperty: Dunng the MreNe (12) months be/ae Decem6er 37 o/lhe year the deduction�e eflec
2) Mobile Hanes assessed under IC 6-7J-7 ormanNacfured homes rrot assessed as real pro ve (12) months
belore March 37 of Ne year the deduction is to be ef/ecWe. GIBSON COUNTY AUDITOR
See reve�se side la atltld'anal insWdions end qualificatims.
Type of beneft reQUasted (p/eate tlieck a9 fhaf apply) I
� Ove� 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Name d appikanf (oxTrer a cantraU bvye�
IS a071imrit ihe sale iepal o itade owneR No, what ia hisfner x shara rn interesf? tl owned with someone olher than spouse.
inditlte wilh whom
Yes ❑ No
tt name on recortf is diftarem Man Ihat d aoolican4 indicate below
Name of contraa seAer (apykanf mutf have bean Ouying m canfraa af loast orre (1) yea�
Adtlress of mntrad seller (numboraiM sbee4 ci�', state, and ZIP code) �s iha pmoerty in Queslion:
Real D�operty ❑ Mobile home (IC 6-7-1-�
Tazing distnct Key numher / Legal descnption Record number Page number
o�j �-/ -/S-.�03- �00. �/ O- �
Is ihe property used and accupiaE primariy for Assessed value of the p�operry as of March 1. cur.ent year (may �rof exceed 5182.<30
his,her ras'Nence? hrO�er 65 dedudion. ar 5760.000 for the Ooar 65 Circ�it &oaker Credi�
� Yes ❑ No
VJas ihe eppliprrt 65 yean of epe or mwa on December 31 of the year Mo����'s tlale of binh (marth, day, yoa� If filed by a surviving, unnartied soouse,
O�orlo Iha wrreM yeal7
Have you lded for any ahar tlatluctions7 If Yes, vmat deduaions7
� Yes � No '
Have yw� flad tor tleductions in any mher couMy? If �§s, whaf counry? ,
� Yes � No �
I/We certify under penalty ot perjury thal the above and foregoing information is Irue and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SignatureWaDdkam AdCressofaoo���rt (numberaMSWCl.ciy.siare,aiMZ/Pwde) � _. � Q
\�. irt.ci(
i� �36 7
Signature authonz o�esantativa AtlOrass of authonzed reD�sentaiive (numberantl strocf, ciry. 9atc. and ZlPCOdo)