HomeMy WebLinkAboutAge_Marshall.• ,•":"w' APPLICATION FOR SENIOR CITIZEN
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PROPERTY TAX BENEFITS
�, State Fwm 43108 (R9l 9-0B)
' ! Pfaunbad by Ihe Departmerit of Loral GovertmeM Financa
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Infortnatiw contained in Mis document is CONFIDEN7IAL pursuant to IC 6-1.142-9 antl IC 61.1-35-9.
rNSrnucnoNS:
COUNTY TOWNSHIP YEAR
fiC
SEP 13 2011
To be filed in person or 6y mail wiN the CountyAud"dor o! the county where tlie property is located. C�
Filing Dates: 1 J Real PropeRy: Ounm� the hveNe (72) mmths be/ore Decem6er 31 0l ihe year the tleducfion is o 6e eff �
2J Mobile Hanes assessed under IC Sf. f-7 or manu/actured hanes rwt assessed as raal property: Ourin9 e (72) monfhs
6e/ore March 31 0l fhe yearfhe tleduction is fo be eRecfive. GIBSON COUNTY AUDITOR
See reverse side 7or addi6onal insVUdions aiM qualibcatims.
Type � baneft repuesied Iprase Moct s0 Nat apply)
�Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name o( apd�M (�� � conVaG 6uye�
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Is appfimM the sde lepal or epuitade rnmeR If No, what is hisTher asad share or interest7 If awned wiU saneone oiher than sooum,
'uWitate vriUi wtrom
es No
If name on rewd'u dMarem Nan Ihat ol applimnt, i�M'uste bebw
Name d mntrsct seAer (a rcanf must have 6een 6�yin9 m cnibad af /ea5 orre (i) yearJ
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Ptldress d wntratl sellar numDer arid sbee4 �: sfafe, eM LP mde) Is Ihe pmperty in question:
�eal property � Mobile home (IC 614-�
Tavngd�st' Kaynumber/Lepaldascription Recmdnumbar Pagenumber
�+ �/t�.�� o�G, l8-�?�a�-aoo_s�9/- a6
Ls Ne pmparty uSeC aM ocapied pirtiarily for Auessed valua o! the qopeM � of Ma(ch 1, wrteM yaar (may nof exceeC 5f82,<30
hisRier residenw7 /oi U.ei 65 tleCUCfian, v f160,000 torlhe Owr 65 Circiu! &ealmr CrediQ
� Yes ❑ No
Was lhe appficaM 65 years of aga or more on �ecembar 31 of tha year
Have yau filed M a�ry other deEuctionsl It 14s, what deEuctions?
� Yes �Jo �'",���,� .
Mava you Fli ed ta deductiore in any othar wurrty? If Yes, what counry?
❑ Yes �.'No
I/We certity under penalty of peryury lhal lhe above and foregoing infortnation is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�ature d ep�faM Address ot appGam (numGwaiW streef, dry, stale, aMZlPwda)
C� � o d S G' �/�-1�e�2.(�-�v0 ��
SignaturadauN representaWe AdtlrasaofaulharaeErepresentaWa (numAerandsfreef,city,slate,endLPcode)
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