HomeMy WebLinkAboutAge_Madden� APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
State Fwm 43708 (R9 / 9-oe)
S u, � p`escnbed by the DepaMrerit otLocal Govemmerit Finance
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IMormation containeC in this tlowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
INSTRUCTIONS:
COUNTY TOWNSHIP YEAR
tl '
Fil M
NOV 1�6 2009
To be fi/ed in person or by mail with the CouMyAUtlita o/ the county where fhe property is /ocatetl.
Filirg Dafas: 1) Real Pioperty: Dunng fhe tweNe (72) monfhs befae Decem6er 31 01 the year the deduction is to hR,�eB7ective.
2) Mobile Hanes essessed urMer IC &1.1-7 ormanufactured Aomes rwt assessed as real property: DUK���2) months
befweMarch37o1NeyearMedetluctionistobaenective. � GIBSONCOUNTYAUDITOR
See reverse sitle M adddionel insWdions erM qualifications.
Type N 6enef.t rapuested (p/ea ec.F e0 Naf apply)
Ovar 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
NameaaaW' mloN,cerorcarn,actoured
Is aoolharrt Ne sde lepal oreQUilable eR If No, what is hisPoer exact share or interast7 H o-xned with somaona other than spouse,
indimta with whom
es ❑ No
M name on record is diRareM ihan �hat of aDdican4 i�iwta 6elow
Name of cont2q saller (apqicant must have been buyiig on cmLact at /east orre (1) ypa�
Add�ass of mntrad saAer (nomber arN sboe4 city, stete, aM ZIP code) Is iha prooerry in quesfan:
� Real pmperty � Mobile homa QC 644-�
T�ing disiriG Kay numbar / legai descnplion Record number PaBe number
� - 3- D -D �y�l- �
b the property used and occupied pnmadly br Assessed value of ihe pmDerty as of Ma¢h 1, wrtent year (may rrof erceed 5f82.430
hislner residen�T (or O�er 65 dodurlion, w 5760,000 /orNe Over 65 C'vcuit &eake�Credi�
es ❑ No
Was lhe epplicaM 65 yeers of age or rtrore on Decambar 31 of t�e year Anolifanfs data of Gtlh (month, day, yeaQ If filed by a surviving, ur..rartied spouse,
pnor to the au�ent yea(! � what was �he spouse 5 age at the time
of dea�h?
❑ Yes ❑ No �' „
Adjusted gross income of appliwn; spouse, and any Source ot �nwme nmount ot Incoma
individuals sharing ownership (FOr Over 65 deduction, income S
may not exceed 525, 000; (or the Owr 65 Circuif Breaker Credit,
incane may rmt exceed $30,000 for individuals, or 540,000 (or y
married couples).
TOTAL $ 0.00
Have you filed Iw a�ry other deducEOns4 If Yes, v.•hat deductions7
� Yes ❑ No
Have you filed for OeEUCtions in any ather cwMy7 H 1§s, what counry?
❑ Yes ❑ No
I/VJe cerlify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1. 20
Signatura of a�M�cerrt Addrass of aOPlipnt (number antl sbeel, cily; sfate, a� ZIP code)
�✓.R..-�- �s-�- t 4 �6
Sgnatura ot aWhorized re0resemawa Address of euthwizad reo�eseotative (numberarM sUeal, ciry, state, antl ZlPcode)
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