Age_TurnerOAPPLICATION FOR SENIOR CITIZEN courrrr TOWNSMIP r�
PROPERTY TAX BENEFITS
Sqte Fwm 63708 (R9 / 9-0e)
•� � Pras�ibed by the DepaNmeM of Loral Govemmerit Finanw � gy
�i. � p p , Fie Mark
Infortnatiom m�tained in Mis doaiment is CONFIDENiU1L pursuant [o IC 6-1.1-12-9 and I 1.4�I§-�� �
�
C
wsrRUCnoNS: �QY 1 6 ' '?2
To 6e Fled in person or by mail with (he CountyAuditor ol the munly where the property is locate .
Filing Dates: 1 J Real Property: During the IweNe (72) morrths 6e/ae December 31 oJ fhe ysarthe _ s to be eflective.
2J Mo6ile Homes assessed urMer IC 61.1-7 or manWactured homes lrof assessed as real e� Dunrg the AvaNe (72J monfhs
belrneMarch3fo(theyearthededuc6onisto6eef/ecfive. GIBSONCOUNTYAUDITOR
See reverse sMe fw additional insWC(ions arM qua/ifiwtions
Type d beneft repuasted ease Metk a0 Naf appty)
Over 65 Deduction 6om Assessed Valuation � Over 65 Cirwit Breaker Credit
Name of appGant (mmw or carrtlac7WyeQ
�'m� � �i,c.r-�e,--
��r�m ure :da iapai or ea���ae ow�ea If No, what is his/her axaa share or iriterest7 If wmetl vrith mmawre other Ihan spouse,
indimte xith whom
� Yes ❑ No
H rame m racwd is diHerent Ihan Ihat W appf�nt, iMicete bebw
Nama o( lmtratl seA r(applmant muN hare bcri� buyirg m contrdcf af least orre (1) yeaQ
�
Addrass ot mntra wller (numbor aM sbeef, ny, sfak, anC ZIP mde) �s the pmPerry in 9uastion:
�Real pmperty � Mobile home (IC 674-�
�mp Key number I Leqal descnption Remrd numbar Page number
a�b,�� Td�n a�-o�-as-� or- voo ��� do
Lv Ihe pmperry usetl aiM ocwpad primarily for Aasassad value of the property az of Ma(ch 7, wrrent year (may irof e.rceeE S7B2,a30
his/ner �sidanm7 lor O�e� 65 d¢dudim, or 5760,000 (or Ne O�er 65 Circuit Breslmr CreCiQ
❑ Yes �No
Was 1he appGram fi5 years ot ape a more on OacemEar 31 M the year
Have yau filed (or airy othar de0uctbns7 It 14s. what tletl�ctionsl
� Yes ❑ No
Have you (Jed fw daducGons in any aher cwmy7 If 14s, what wumy?
❑ Yes No
IIWe certify under penalty of perjury lhat the above and foregoing information is true and conect and that the applicant was a resident
of Indiana and owner o( the aforementioned property on March 1, 20 _
SignaluredappfcaM P.ddrassafapplirant}n�ixnbararMS6eef,uty,sfafeandZlPmCO)
� � � . %� 0 . .cic� d.j.z i�a.� �ic.. �7� (� L�
Signatura of auNwized rapresertlativa AEErass of aWhor'rmd repesentative (nvnber aM slreeL �Y. �7e, end LP code)