HomeMy WebLinkAboutAge_Morrison�"' „ APPLICATION FOR SENIOR CITIZEN
.;. .. PROPERTY TAX BENEFITS
� - �'• StateFOrtnd3708(R9/9-08)
P�esaihed 6y the DepeM1mant ol Local Govemmem Finance
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IMwmatiom m�tainetl in this documen; is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1 J-35-9.
INSTRUCTIONS:
� COUNTY TOWNSHIP � YEAR j
�`I��t�
To 6e filed in person or 6y mail with the CountyAUditor ol the tounry where the property is locafed.
Filing Dates: i) RealPropeRy: Dunng fhe lweNe (12J months be/ore December3l o/the yearthe deductlon is lo be s/�.E1�e. 1 Q Z���
2) Mobile Hwnes essessad under IC 67. 7-7 or manulactured hanes not assessed as real property: Dunng the tweNe (12) months
betore March 37 o7the yearfhe deduction is to 6e eNective. `�j
See reverse side Iw atlddional insfruGions arM pualifications. /�'��` J'����
TypeofbenefiraQUasfed(doasarliackauNaiappy� GIBSON CO��� �' "" ' -
� er 65 Deduction from Assessed ValuaGoR �! Over 65 Circuit Breaker Credit
Name of appGcaM (mvnor a
-^-+ ..
Is aoDlica(n th de legal or aQUitaWe owne�! Nq what is nis/ner exact s�are or c.teres�? If owned wi�h wmeor.e cihar Ihan soouse.
� indinie witn vnom
�'es ❑ No
If nama rn remrd is diflerant ihan Ihat of a�dicant indicate beiow
Name of mntact sallar (apd� ant musf hero boon buyinp on conbzct at leasf ono (1) yoa�
IPddress of mntratl seller numGw eM s7ce4 �'. staro, arN ZIP mtle) Is tne o�oetly in ouestion:
I Real properry � Mobile home QC 64-1-n
ng dis . c1 Kay numoer / Lagal daunotion R�corE numSer PaBe number
l2� �-o�F-a�-3oo -000.�� -oao
Is ihe xnverty used and occupad primady for 0.5sessed value ot the orooerty as of Ma¢h 1, curtant year (may rwt erxetl S:d2,e3G I
his/her ras'Meno7 for Otier 65 tloCUIXion. or 51fi0.000Ior the Ovr� 65 Circ�irf &caker Cmii�
� Yes ❑ No
VJas ihe ap0��m 65 yean o( age or mwe on Dacember 31 of the year
Hava you filed fw a�ry Uhar tleduUions7 If :es, w�at ceduciiar.s?
� ❑ No
Have you fJad for deEUCUOns in any at�er munry7 �f �'es, what covnry7
� YES �`IO
I/We certi(y under penalty of perjury thal lhe above and foregoing information is true and correcl and thal the applicant was a resident
of Indiana and owner of the aforementioned properiy on March 7. 20
ISgnature ot apd��� PdEress of aPOlimnt (number antl svicet, ci.y, state. and ZIP rqEe)
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Synature W onzeC raorasenfativa Address of aN�orizad reoresemative (numGCrantl s:reet, ci:y, state, and ZIP coEO)
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