HomeMy WebLinkAboutAge_Culbertson"'"w APPLICATION FOR SENIOR CITIZEN
_ - PROPERTY TAX BENEFITS
� - Sfate Form 43708 (R9 / 9-0e)
•� f Prewibad by Ne DepaNmeM o! Lod Govemmerit Fnanca
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Information containetl in t�is docvmenl is CONFIDENTIAL pursuant to IC &1.1-12-9 and IC 67.1-35-9.
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INSTRUCTIONS:
TobefiletlinpersmorbymadwiththeCountyAudifaolthecountywhereNepropertyislocated.- GIBSONCOUNTYAUDITOR
Filing Da(es: i) Real Properfy.� Dunng the tweNe (12J mmths belore Decem6er 31 0/ Ihe ysar the deducfion is to 6a effec(ive.
2) Mo6i/e Hanes assessed urMer IC &1.1-7 or manu/acfured homes rat assessed as rael pioperty: Dunrn� Ihe AveNa (12) mon�s
6e/we Marrh 31 0! fhe year the tleduction is lo be eflec6ve.
See ievarse sde fa atltlitional inshudions erM qualifications
Type ot beneH requested (p'ease rhetic a➢ Ihaf ePply)
er 65 Deduction from Assessed Valua6on � Over 65 Circuil Breaker Credit
Name o! appGraftt ( or cmlraU MryeQ
S
Is appfuant lhe sde lepal orequitaWe owneR H No, what is hisRie exad share w imerastl If awneE wkh mmeana other than spouse,
iMiwta vn�h whom
�Yes ❑ No
H rema on recwd is diRerent than ihat d aoo��t ���a ��'
Nama of corttracl seAet (applmant must have been biryirig m cmhact af /east orre (1) yparJ
AEdress o( mnbatl seller (nwnbm a�d stree4 �', sfafe, aiE LP mEe) Is the pmperty in quaztion:
eal property � Mobile home QC 674-�
T�j� a'¢}� Key number / Lagal descnplion Record numbar Page number
-IV-Iq- c�l - - bb
la the prapaM used aiM awpied primady Asseued valua of lhe pro0arry as of March 1, wrtant year (may rwt arwed SiB2.430
hisiher residenoa7 (or O�er 65 derl�rlim, n f160,000 for Ne Ovw 65 Circuit &eaker Credm
�Yes ❑ No
Was lhe appGraM 65 years ot age a mora on December 31 ot ihe year
Have you fded for aery Wher datlin,tionsT if Ves, what Ceduc�ons7
�es � No
Hava yo� filed tn deduclians in any W her county7 H�4s. what couMy?
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VWe certify under penalty of perjury lhat the above and foregoing infortnation is true and wrtect and that the applicant was a resident
of Indiana and owner of the aforemen[ioned property on March t, 20
Signaluredappliram AddrassofaDO��nt (numberarNstreet,rity,sbfn,erMLPwde)
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