HomeMy WebLinkAboutAge_Winstead (3)APPLICATION FOR SENIOR CITI�EN
rt. � PROPERTY TAX BENEFITS
State Fwm 43768 (R919-08)
� S uu � Prasuibed by the �epartmant ot Local Govemmerit Finance
Information o�nained in ihis dowment is CONFIDENTIAL Wrsuant to IC 6-1.1-72-9 and IC 6-1.1-35-9.
�
�
INSTRUCTIONS:
COUNTY TOWNSHIP � YEAR �
� ����
7o be filed in person or by mail witA Ure CountyAUdifw o/ the county where the property is located. q
Filing Dates: 1) Real Propedy: Dunrg the IweNe (72) monUts be/ae December 31 o7fhe year fhe deduction is to be �e.2 ,9 L���
2) Moblle Homes assessed under IC 67.7-7 ormanulacfuretl homes rrof essessed as real proper(y: Dunry fhe tweAre (72J monfhs
be(ore March 37 0/ lhe year the tletluc6on is to be eIlective. � � d
See reverse side for additional insVVUions errd quelifications. ����'
��
Type ot Eaneft repuested (pease dieck eB fhat appfy) GIBSON CO
Ove� 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit
Name d apd�M (ovnier d contract DuyaQ
� �
,' �' ,` �'/)'A u��- � �i,� .CO
Is aoolimnt the sde lepal oreQveabia owne(/ I( No, what is hisll�er exact share or interest7 If owned with wmeone oiher than 50ouse,
indifate w�ih wtwm
Y� o Na
H name on recard is diReeerit than Nat of aDd�cent indiwte belmr
Name af cmirzp seller (appficanf musf liave Deon buyirg on cmfrdG at leasf oiw (f) yearj
AdOress o( mntraa seller (num6eranrl s6eet cdy, s�ata. and Z/Pcode) Is the prooerty in pueslion:
� Real prope ,ry � Mobile home (IC E74-7)
Tax' islncl i Key numbar/ Legal descnolion Rerord number Page r.umcer
- -�3�%/03-�4-D. �D/-0o1
i: �,a Proparry o:aa e�,a ox�,roee or��y wr lusessed value ol lha pro0erty as of March 7, wrrenl year (may rwt eresed 5182.430
hivher residenw7 /ur Orer 65 doduGan, a t f 6b.0001oi Ne Ovar 65 Circurt Breeker Credi�
�Yes ❑ No
VJas ihe e0W��165 years ot ege or more on December 31 d the year
Mava you filed br arty othar deductions9 II Yas, v.Tat ded�cGonsT
� Yes � No
Have you (led tv EeEuctions in eny olher courrty? If 16s, what counry?
� Yes ❑ No
I/4Ve certify under penalty of perjury lhat 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
Sigratura o1 apd�M Pdtlress of ao0���'an� (numbm antl stroef. ciry, stafa, antl ZIP code) �
G-�-�-� � �%�.-�-�-� ��� .� �,�.-P�,� �� ,.�-�'� �
Signatura d auNOnzed ra�reser�tativa ACdrass ot aulhaized re�resantative (numDerantl s:leot, ciry, sfafe, anG ZIP codo)