HomeMy WebLinkAboutAge_Kerns� "'" APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
•5��� State Fam 43]08 (R9 / 9-08)
Presaibetl by ihe Departmer�l ot Local Govemmerit Finance
�
�
Informatiom m�tained in this tloeument is CONFIDENTULL pursuant to IC 6-1.1-12-9 and IC Gt.t-35-9.
wsrnucnoNS:
COUNTY TOWNSHiP YEAR
r!OV 0 9 2ot1
To 6e filed in person or 6y mail wrfh the CountyAuditor o/ fhe oounty where the property is located. ^
Filing Dates: 1) Real Property: Dunng the fwelve (72J monfhs 6e/ora December 37 olthe year the deUuctioiisYb /
2J Mo6i/e Homes assesseU urMer IC 61.7-7 0� manu(acturetl homes rwt assessed as real pmperry: Dun e (f2J months �(/
6efaeMa�d�3fo7theyearlhedeUuctionisto6eefiective. GIBSONCOUNTYAUDITOR
See reverse side fol eddifional insWcfions arM qualifiwtlons.
Typa d baneft �ua5ad (pleasa rheck aa fhaf appy)
❑ er 65 Deduction 6om Assessed Valuation �,Over 65 Circuit Breaker Credil
Name of appGCaM (ownor or cmtrscf bvye�
� er
Is app6mM Na sde lepal or equitable owneR K No, what is his/her asact share w intarest? If amed with mmeone othar than sDOUm.
intlimte with whom
❑ Yes ❑ No
If reme on racad "u Ciflarant Ihan fhat d apqiran� indicate beb«
Name of conlaG seller (apd�nf must hava been buy7ng m canl2c! at Masf one (iJ yea�
Pddress d wntratl mAer (mim6n aM sfreef, cdy. sfafe. aM LP mda) Is the Proper�y in 9uestion:
al property � Mobile home (IC 674-�
Taaing d¢tricl Key numbar / Lagal Eesuiptian Record number Page number
Q �
Is Ihe pmpary wad and occupie primarily (or Aasessed value ot lhe pmperry as ot March 7, wRent year (may irot oxwod f182,430
hisiher residenwT lorO�er 65 Cedudion, or E760,O00 /or No Orer 65 Cirnal Breal,er CiotliQ
� Yes ❑ No p�
Was the appfrant 65 years o( age w rtwre on DecemDar 31 d ihe year
r�a ya rum ro. em ana� am�:a u�. �� aea�no�?
�Yes �No
Have yau (Jed Iv deEuctions in anY �er awnry7 If Yes. whal couMy?
� Yes � No
VWe certify under penalty of perjury thal lhe above and foregoing in(ortnalion is frue and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 � � -.
SignatureofappGraM Pddressotapplimm (mim0erandstree4�:��.�ZlPwde)
FO�� Ilo
� c
Signature ' uNORZetl reprasentative l�Gdress of authorimtl repfasentativa (number arM street rJty, sfate, and LP mde)