HomeMy WebLinkAboutAge_LemmonsAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
� - -' State Form a3708 (R9 / 9-OB)
Prascribed by Ihe DaparCrerrt of Local Govemmer�t Finance
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intormatbn oontainetl in Mis Cocvment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC G7.1-35-9. //
INSTRUCl10NS: N
TobefileCinpersmorbymailwNhfheCountyAudiforolthecountywherefhepropertyislocated. GIBSO�� TY AUDITOR
Filirq Dafes: 7) Real Prtrperty: During the MreNe (12J mmths 6e%re Decembei 31 01 the year the deductlon is to be eRecfive.
2) MoW/e Homes assessed urHer IC 6-7J-7 or manNactured homes rrot assessed as real pioperty: Dunrrg fAe hveNe (12) montlis
be/ore March 3f o) the year the deduction !s Jo be ellnctive.
See reverse side /ar adddionel InsWCtions an0 qualiflcatlms.
Type of bafreN reduested (please dieck a9 Nat appy)
�Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Named ifaM/owrreracm WyeQ \
�di
Is eppG�m Ihe sd I orepuitaMe owneR t( No, what u his/net exaq share w intarest7 H ownatl vnih somawe oUer Ihan spouse,
intlinte with whom
❑ Yes ❑ No
H rame on remrd ia ditfarant Nan Ihat of appGrsn� iMiceta bebw
Name of coniracl eeller (eppicenf musf have beon Duying on conhact al kas( orre (1J yea�
Addrass of wntrad seDer (rnimba antl sbeeL cdy, afefe, end ZIP code) Is the o�oerry in puesYron:
� Real property � Mobile home QC 64-1-n
� T�ing tlistriq Key number / Lepal descnption RecoN numbar Paga number
�,t� a� -i8-�.�-yva -000 go�-���
b Me D�OeM � arM accupiad primariy for Assessed value of lhe pmDerty as of March 1, cunent year (may irof exceetl 5782,d30
his�her residenca7 /orO�er 65 deduGion. or 5160.000/or No Ovei 65 Ciicuit &oakar Credin
❑ Ya5 o No
Was ihe appGCeM 65 yean of a9e or mwe on December 37 of tha year
Have you filed for arry other deducfions7 I( Yes, what dadutlionsl
�,�5 o Na s. �
Nave yw filaE for deduc6ons in eny Other countyi If 1§s. what courrty?
❑ Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and lhat the applicant was a �esident
of Indiana and owner of the aforementioned property on March 7, 20
' rature d eppika Addrasa of ev0��� (��bw aiM sboel. cily, SWte, a� Z/P ootle)
/o lr/- ' --.�F'� � �'
Signa oA represe ative P-0Oress of euthorizad rawesantative (numLwaM sUeef, city, sfato. and ZIP co0e) /�7 f/�