Age_WilliamsAPPLICATION FOR SENIOR CITIZEN
s _- - PROPERTY TAX BENEFITS
State Fortn 43708 (R9 / 9-0e)
� ' � PrescribeE by Na DepartmeM of Local Go�emmam Finance
Informatiom m�tained in lhis document is CONFIDENTIAL pursuanl lo IC G1.7-12-9 and IC G1.135-9.
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�NSmucnoNS:
COUNTY TOWNSHIP YEAR
APR 11 2012
To be fi/ed in person or by mail with the CountyAuditw ollhe county where the property is /ocated.
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Filing Dales: i) Real Prtperty: Dunng Ihe (weNe (72) marths 6efare Decembar 31 0! the year fhe deducfion is to 6e efl "
2) Mobile Hanes assessed urMer IC 61.7-7 or manWadured homes rwt assessed as real propelly: Dunrg the J monfhs
belore Marrh 37 ofthe yearthe Ueduction is to 6e efiactive. GIBSON COUNTY AUDITOR
See reverse side fw atld'Nonal insWdions arM qualfiratlons
iype d baneH raquested (pleasa rheck a� Naf appy)
� Over 65 Deduclion 6om Assessed Valuation �Over 65 Circuit Breaker Credit
Name of appfparit (owner w cant2G bvye�J �
Y �
Is appGmM the sda lagal or apuifade wmeR If No, what is Ns/ner esact share a iMere�7 N amed wiUi swnaona olher lhan spouse,
'ufdimte vriih whom
❑ Yes ❑ No
It name on raco�d is tliRerant Ihan Ihal of aOW�nt, iiMicete below
Name d cantaG seller (applmanf must hare 6ean Duyirg m cmtracf af ka5 orre (7J yea�f
Adtlress d wntraC 5eller (numEOl ari0 s6ee4 �: stafe, aM ZIP mtlo) �s ihe pmperry in question:
eal pmperty � Mobile home QC 674-�
Tazing district Key number / Lagal descnption Record number Paga number
Z- - - -� � 066 y��
Is tha poperty used and ocwpiad primar�ly for Assessed value ot Ne propeRy as ot Mamh 7, wRem year (may rmt exceed 5782,430
his/ner `esidenca7 fur O�er 65 tledurlian, v E160.000 hiNO 0.er 65 Circut &eaker Credi�
❑ Yes ❑ No
VJas ihe appfzam 65 years of age w rtrore on Oecembar 31 of lhe year
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Have you (JeE for ary other tleCUCCOns? Ii 14s, what OeducUOns4
� Yes � No S
Hava you (Jed tor deductions in any aher cwnry? It Ws, what coufrty?
� Yes �No
I/VJe certi(y under penalty of perjury that the above and foregoing infortnation is We and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signaturedappfxant L^G��'� J PdErassofaPGGmM Nwnberandsbuot.tlry:sta arrdZlPwde)
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SignaWra W auNmrzetl prase tive Adtlress of aNhw'rmd represeniative (numberaiMSbaof, city, sfate, and LP cotlo)