HomeMy WebLinkAboutAge_Dyer� APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
` �' Stafe Form 43708 (R9 / 408)
P�esaibed by Me Oepartment of Local Govemmertl Finarrce T
Infwmatiom m�tained in this document is CONFIDENTIAL pursuant to IC 6-1J-12-9 and IC 6�1.1-3�:"1
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INSTRUCTIONS: 9 n
To be filetl in person orby meil with the CountyAUdrta olfhe county whera fhe property is /ocatetl. �u N 1 1 Z��J
Filirg Dates: 7) Real Property: Dunrg fhe fweNe (72J mmths be(orB Oecem6ei 31 o/fhe year fhe deduction is to be effecfrre.
2) Mobile Homes essessetl urMer IC �7.1-7 or manWactured Awnes not essessed as real p�,�p e7rty: Du�jqg,Ihe hvelve (12) months
belare March 37 0/ the yoer the deducbon is to be ei/ective. p'� 6� F� i5��
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GIBSON
Type M OenePo repueated (p'oese tl+eck a0 Naf appl�
� Over 65 Deduction 6om Assessed Valuation �Over 65 Circuit Breaker Credit �
Name of appfmar�t ( confiect CuyerJ
�
Is aoP��mM the sole lepal epuitable owneR It No, whal is is/her exact s w irteresl7 owned with someone other than soouse.
indiCate with wtwm
�es ❑ No
M name on record is diRereM than �hat d apqican4 iMiceta babw
Name of corrtraa seAer i nf must have baon buying wn cmuaci af lea5 orre (1) yearj
� Pddreas of cantrad seller umboreM sbeeq cdy, stefa, and Z/P code) Is the pmpetly in Question:
, � Real property � Mobile home (IC 6-7-1-n
Taainp dist' Key number / Legal Caecnpibn . Recortf numDer Paga numher
� a� -a� -oa-y�l-c�.iss-�3
U Ihe Woperry used eM occupied primariy (or .4ssesseE value of lhe property as of Ma�ch 1, wrrent year (mayiro( axcea0 St82.430
hisiher (esidence? !or O.er 65 daduC'qn, v f7fi0,000 /or Ne Oua 65 Cucuif Breeker CrediQ
�1'es ❑ No
Waa the appGwnt 65 yean of ape or rtare on December 31 d the year Aoo�nfs da�a ot birth (mantA, day,
o,a��,
AdJusted gross income of applicant, spouse, and any Source oj.� come Amount ot Income
Individuals sharing ownership (ForOver 65 deduclion, income S O SS/ /
may not exceed 525, 000; (or lhe Over 65 Circuit 8reaker Credif, �T �
income may rat exceed $30,000 for individuals, or 540,000 for g I
married couples).
TOTAL 5 0.00
Hava you filed for a(ry oNar tletluctimsl If Yes, wnat deductlansl
❑ �5 �Ma
Mava you filed tor deduclions in any Mher couMyi If 1§s, what cwnryl
❑ �5 ��
IIVJe certify under penalty of perjury thal lhe above and foregoing infortnation is true and correct and that tha applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�$ignetura af appficartl Pddieas of aoCG�m (nwnDeraiW sboef. ciry, state, a�H Z/Pcode) ���
C� �� J �.1�, , -
Spnature of authorized aeritativa Md�ess of authwized rapresentative (numberand s✓co; ciry, sato, end LP code)
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