HomeMy WebLinkAboutAge_Crawford� .�az APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
� sace Form aa�oe pxs i s-oa�
� ! Presrsibed by the Departmerit of Local GovemmeM Finance
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Infortnatiom m�iained in this doamenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC Cr1.135-9.
COUNTY TOWNSHIP YEAR
FI
wsrRUCnoNS: FEB 2 3 Z012
To be filed in person or by mail with the CountyAUtlifor o! the county where the property is locatetl.
Filing Dates: i) Real Property: Dunng the hveNe (12) months 6efrne Decem6er 31 0( fhe year the deduction is to 6e'a7tec�
2J Mobile Homes ascessed urMer IC 6-7.1-7 ormanulacturetl hanes rro( assessed as reel pmperfy: Dunng the �(72),months
6e/oreMarch3loifheyearthedeductionislobeeflective. GIBSONCOUNTYqU TOR
See ievefse sitle foratlditional insWctions antl Qualificatlons.
Type W benefl requested (yca Meck aAfhat appy)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ^app6rar�t (awner w r.mlrad Duyo�
V � I ' - 1
Is applimM lhe sole legal orequitable ameR If No, is his/her exad share w interest?� If w+ned vrtth mmaone oiher ihan spousa,
_ indiratewilhwhom
� ❑ No �
H�me on record is ditferent than that o( appin-ant indicate belrnv
Name of mdad sa0er (applicant mvst hare been buyiig on conLact at /easf oire (i) yearj
Address of mntratl saller (num6erandstree4 Gty, stale, andZlPmEa) Is the p(operty in question:
� Real pmperty � Mobile home QC &14-n
n isirict Key number / Legal descnption RecoM n�mber Page numbar
�6-12�.-0'l-3o�-�oa-o3- oa8
Is �ha propeM �� afM occupied primariy tor .
Have you fied fw arry other deducGOns7 If Yes, what tleductior�s?
�Yes �No
Have you filed for tlaductions in any other murrty7 If Yes, what coufrty?
❑ Yes � No
I/We 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 ihe aforementioned property on March 1, 20
Signalureofapplicant Addressofapplinm (numberandsGee4ciry,sbtu,alMZlPmde)
Si nature o(auNwized representativa PAtlress of authorized representalive (num6orand street, city, stafe, and LP ca/e)