HomeMy WebLinkAboutAge_Arnold (2)" APPLICATION FOR SENIOR CITIZEN
S� � PROPERTY TAX BENEFITS
'I�j,�,' Sbte Fortn 43708 (R9 / 9-OB)
MS�� Prescribad by Ihe Deoartment of Lacal Govemmen� Finance
Infortnation wnlained in this doament is CONFIDENTIAL pursuan� to IC 6-1.1-12-9 and IC 6-7.1-35-9.
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DE 3 1 2008
File Mark
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Tobefiledinpersonoi6ymaiiwith(heCounryAuditorolNeoountywherefhepropertyislwated. GIBSON COUP!TY AUDITOR
Filiry Detes: 1) Real PropeRy: Dunng the fweNe (72J months belore December 37 ollhe ysar fhe deduction is fo be e/lec(ive.
2J Mo6rle Homes essessed urMer IC 6-7. 7-7 or manulactured hwnes not essessed es real pioperty: OuAng fhe hveNe (72J mmths
before Mardi 31 olthe yearihe detluction is (o be eHecfive.
See reverse side 1or additional instrudions erM qualificafions.
Type d beneN reQUested caso rheck a0lhaf apply)
�Over 65 Deduclion from Assessed Valuation �Over 65 Circuit Breaker Credit �
Name pD�cam (ownm a caMracl EuynQ
%�1A'i.t.�-�-`-'"
Is apP rtl t e sda legal or eQUiWWe awneR �1 No, whal is nislhar eaact s�are w inleresl7 If owne0 witn sameone other Ihan spouse.
indita�e with xfiom
❑ Yes ❑ No
It name w record is diflarent Nan Nat of eod��4 indiwte babw
Name of conlmct sellar (epplicanl must have becn 6uyirg on canf�ad af /cast ono (i) yoa�
P4dress of mntratl seller (namDeraM sbcet, <Ry, sfaM. and ZIP mdo) � �s 1ha D�ooeny in Question:
� Real propery � Mobile home (IC 6-7-1-n
�' Tazinq d'uinct , Key numbeN Lagal Eewno�ion I Racord nvm5er Page number
�- I -/S - 30/- Dao. o Sd -0�7
Is Ne pro0erty used and occupad D��� Assassed value of the omoerty as of Marc� t, curtant year (may not exceetl ">182.430
hielner residenm? lor Owr 65 tlo0urlian, w 5160.000 /or the O�.cr 65 Circui; &eaicer Cretli�
❑ Yes ❑ Na
Waa the app6cant 65 yean o( age or rtwre on Decembar 31 ot t�a year
Have you fded tor ary othar deEUCtiw:s? If ves. what eaductar.s?
�Yes � No �
Hava you (Jed tw deductions in any other counry7 ( It Yes. whal wunty?
� Yes ❑ No •
IIVJe certify 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 _
' neture of aod�nt MOress of ao0��� (numbe�antl sboef. ciry, sfa�e. and ZIP cotle)
�.�,� T 6�- l/,� G t
' a�me o(authOnzad rapresent e AEdress ol aulhorizad reD�esBntaliva (numbcrand s:2N, ary. s(atc, and ZIP code)