HomeMy WebLinkAboutAge_AnkneyAPPLICATION FOR SEN�OR CITIZEN couNn � TOWNSHIP � r�
PROPERTY TAX BENEFITS
smm Form aa�oe tas i 3oel �
���• Prescribed 6y ihe Oepartmam of Local Govemmem Finance
File Mark
Informatan containetl in this Cowment is CONFIDENTIAL pursuant lo IC 6-1.1-12-9 and IC �5-9.
INSTRUCTIONS:
APR 1 3 2010
To 6e filed in persm or by mail with the CountyAuddw ol fhe munty where fhe propeRy is locafed.
Filing Dates: 7) Real Propeity: Dunrg fhe tweNe (72) marths 6efore Dewmbei 31 of the year the�]�l�d�,�( r n i flective.
2) Mo6de Homes assessed urMer IC 61.7-7 ormenu/actured homes lrot assessed 6s rea�perty: nr� Ur hveNe (12) montl�s
be(a+s Marc� 37 o/the yeer the Ceduction is to 6e e//ecGve. GIBSON COUNTV AUD�lO�
See reverse side /w adtldional insUVCtions arrd quali6calions.
Type of benefit repuested (yeas eck e6 Net epply)
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name d apd�wM (o�++a' a tm7ad Duyv�
rn �
Is ap0licam the sde Iegal or ep Me ameR If No, what ia hisRwr eza share or L;tarest7 H owned with wmeme dher lhan spouse.
iMimta with wMm
❑ Yes ❑ No
K name on record is dilfarem than thet d appikant, InOicate below
� � � � v —P / �"� w
Name oi contrsd seller ( ¢anf must hare Ooon buyirg an cmtrdd at�%�n '
��. o��.�.
AdCrass N mntrad seL (nwnber aiM abeo4 �: state, anE ZIP co0e) Is (he prooaery in puestion:
� Real property � Mobile home (IC G74-�
� ing diatnp Key numbe� / Legal tleunpiion Record number Page number
� ab -� f�: � -� a-ooa. �
Is Ihe properry used arW occupiad primady br Assessatl value ot lha�pmperty as of Mart'h 1, curtenl year (may nof axceed 5182.430
hisfiet re5ideno7 lor O�e! 65 deductian, a Sf 66.000 fir Ne Ovar 65 Circuif &aeker Gadi�
es No
Was the appGCam 65 yaars of ape or mwe on December of the year
Nava yw fJed for aery oLtiar EadutEa+c7 It Vas, whal ded�dionst
❑ Yes ❑ No
Haveya+(Jetlfordedudonsinenyahercounry7 ' IfWs.whatcounry?
� Yes ❑ No
IIVJe certify under penalty of perjury thal the above and foregoing information is We and cortect and thai the applicant was a �esident
o( Indiana and owner of the aforementioned property on March 7, 20 .
SignaW ra ot appihar� Adtlresa of acotipnt (num0er and stroot. ciry, staro. SiM ZIP wde)' '' '
1 • � � '
� Sgnalure W euctionzed reD�esentative Mdrasa oi euthorizac reoresantative (num0elarN stree4 ciry, sta:o, and LP codo)