HomeMy WebLinkAboutAge_Blumej='°a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courrrv TOWNSHIP YEAR
a = RE�UESTING DEDUCTION FROM ASSESSED VALUATION
`• �• Sta;e Form d3708 (R / 9-96)
';�O l Presaibed by Ihe State Board of Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-72-9. File Mark
INSTRUCTIONS FOR FILING � � � � � �
To be liled in person or by mail with the County Auditoi ol the county where the property is loca- � -
ted during the 12 months belore May i l o/ the year the deduction is to be el)ective. ,,, n n L�U(�Q
Deductions for mobile homes not assessed as real property must lile be7ween January 75 and rIPQ� L
March 31.
See reverse side for additional instruction and qualifications. � ,� ����
(owner or contract buye�)
Is applicant ihe sole legal or
If No, what is hisfier exact
�es ❑ No I
If name on record is diHerent than ihai of applicant, indicate below
Name of convact seller (applicant must have been buying on contract at leasl one (7)
of contraci seller
��
� property used
=.r residence?
s Ihe apphtant 65 years oi age or more on ueci
u to the current year?
1 I�
rliranfs date of binh (month, day, year)
ed by a surviving, unmarried spouse, what was
time ot death7
you filetl for any other tletlucffi
you filed for deductions in any
❑ Yes
�� o
❑ No
he year
age at
■ .
I� oWnBtl Wlth SOmBOn2
indirate with whom
�s-8��-oa I I
Assessed value of the property as of March 1, current year
exceed $21,000)
❑ Yes
Does the combined annual adjusted gross income of Ihe aE
individuals sharing ownership exceed 520.000?
spouse,
not
any
❑ Yes � Ple-�
Source of Income Amount oi Ineome
�$
TOTAL I $
I/VJe certify under penalty of perjury that the above and foregoing information is irue and correct and ihat the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 79 � .
ature of applican � /J Signature ot auihorized representative (by executed Powe� ol AttomeyJ
L�/ %
7�ae.�>-,.�J
ress of applicant Address of authorized representative
�����
� ��� I� .
i�
.�
. . FILED
•.,;;"w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR j
_'`''r1 z PROPERTY TAX BENEFITS APR NO
State Form 43708(R9/9-08) .
•' ones Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. GIBSON COUNTY AUDITOR
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested se check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of app/ m(owner or contract buye/,
�(G 5r/`/
Is applicant he sole legal or equitable MV/TA(0 If No what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the properly in question:
x I Real property ❑ Mobile home(IC 6-1-1-7)
Taxing �
,y� Key number/yLLegal descritption/y1 `t ,r Record number Page number
Is the property used and occupied primarily for
❑ Yes ❑ No
INJe certify under penalty of perjury that 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 .
Signature of applicant dress of applicant (number and street,city,state,and ZIP code)
Signature of authorized repres 6e C-'•�/
_
r Address of authorized representative (number and street,city,stale,and VP code)