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� "' APPLICATION FOR SENIOR CITIZEN cou . r N H r
. PROPERTY TAX BENEFITS -
� ' Shce Fortn 43708 (R919-OB) .• � �u
Prexnbed try ttie Deoartmam of Local 6ovemmem Finance U N 2 5
File Mark
Informatbn coniained in this doairtrent is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 67.1-35-9. ��� �
6
WS7RUCnOn/S: GIBSON COUNTY AUDITOR
To be filed in person or by mail wdh fhe CountyAUditw o! the county where Ne property is located.
Filing Defes: i) Real Piopedy: Dunng fAe fweNe (12) months be(ore Decem6er 37 of the ysar the deduction is to be effective.
2) Mo6ile Hanes assesse0 urMer IC fi7JJ ormanufactured homes nof essessed as real property: Dunrg the twelve (12) monMs
belore March 37 0/ Ne year tAe deduction is to be eflective.
See reverse sitle (w edddional lnsWdions arM qualifitations.
Type d benef.t �uesie0 (please tl�eck e0 Naf apply)
er 65 Deduction 6om Assessed Valuation �Over 65 Circuit Breaker Credit
Name d applrczM (owire� or ctMracf OuyerJ�
// / 1/7 ��, ,� �
� `CJ w(/�YJ�
�s aov���m tne sae iegei o uRable ovme// If No, what is hisRier exad ahara w interest7 H ownad with someone othar than spouse,
indicate with whom
❑ Yes ❑ No
H name on record ia diflarerit Uun that d appfirant ��dlceta belo«
Name of cmtad seller (applicant must hava been Duyiip on conf2a at besf orw (7) yeah
� PdOress o1 mntrae seller (numbei ard abael cify, sble, arW ZIP wde) �s tne D�oeny in Question:
eal property � Mobile hane (IC &7-7-7)
Tazi`ng'dlstncl Keynumber/Lepaldescription Racordn�mber Pagerumber
� � �Z= =Q`
Is Uie pmpeM uaed and occupied primarily br Assessed value of Ihe pmparry as ot March t, curtent year (mey rrof exceaE 5182.430
hisRier iesiEence4 (orO�ei 65 deduCian, a 4160.000 !or Ne Ove� 65 Cucuif &oeker Gedi�
�Yes ❑ No
Waz Ne eOM�m 65 yeara of age w more on Decamber 31 of tne year
Have you fJed for arty o(har deCUCEma7 If Yes, wfiat deauctions? ����
�, Yes � No / �(
Have you fAad lor deE�ctions in any aher mumy? If Yes, what coumy7
� YBS �J NO �
UWe certi(y under penalty of perjury thal the above and foregoing iniortnation is We and correct and lhat lhe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
�$igr,ature d 2pditeM AEda55 ot aOP�mr.� (numbcr aiM sbool, crry, sfafe. aM ZIP coEe)
x �5"/� S Th
Signature ot authai e0 seMaDVe AdEIB39 07 BNIIOdiBd �¢D�eSeNa�ivB (numEOr and sboef, ciry, sfato, and ZIP coLO) �