Age_Dasch� APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP I YEAR
. PROPERTY TAX BENEFITS
� "' Sbta Fortn 43708 (R9 / 9-08)
Pfascnbed by the Dapartmem of Local Govemmem Finaxa
le k
Infomiatiam m�tained in Nis tloament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUC710N5: 1
To be filed in person or 6y mail with fhe CountyAudita o/ the county whera fhe property is /ocated. A P R 5 2 � � 1
filirg Dates: 7) Real Property: Dunng the tweNe (72) mmNs before Decem6er 37 o/fhe year fhe deduction is to be effective.
2) Mobile Homes essessed urrder IC 6-7J-7 or manu/actured hwnes rrot assessed as raal pmpe� - (72) mrnfhs
be/ore Merdi 37 0/ the year fhe deduction is fo 6e eflective.
See ieverse side for adddional insWdions errd qualifications. GIBSON CO U NTY AUDITOR
TYDa d beneft `epuastad (pl rheck e9 fhat app1�
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of aOD�M (owr�r or carNact Ev}eQ^
�/ v �C. �V ��
ia aodimm tne we iepai orea�na�e ownen I( No, what U hu(ner ezad share w it�eraEt7 H owned with spneone ofher than spouse.
indi�ate wilh wham
C� ❑ Na
H name on rerord is diflaraM ihan ihat of a0d��l indicete hebw .
Name of confracl eella (epplicanf musf furo bocn buying m cmtrdc+af loasf orce (1) yearj
� Address ol mntrad Aer (�er aiM sbeet ciry. stale, aiW ZIP oode) �s the Dmoerty in Quastion:
� Real property � Mobile home (IC 67-1-�
T�inp Key number / legal descriotion Record number Paga numoer
`�/l..v►�.c�t�- ac� -i i-i�i o�+-��o.s3� �
Is the pmpery useE and occupeC primarily (or Asseued valua af the o�Party as of March 7, cuRant year (may nof oxcceC S iH2,e30
hisiher rasidanw7 �r O�er 65 dodudian, or 5160.000 !or the O�er 65 Ci2ui( &ookcr Ciodi�
i
es No
Was the eDW�M 65 years ot age or more on Dacember 31 ot ihe year
rlave r«� elea ro. am mnar aaeuaons'7 �r Vea. wna� aeaua;onsi
� Y8S �'�O
Have you filed for deductions in any other courRy? — / If �§s, what counry7
❑ �S I� "`�
IIWe certify under penalry of perjury that the above and foregoing information is tr�e and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
� Signatura d a rrt Pdd�ess of aoPlimnt (numEm en0 sboe; crty; state, a Zl� , j L ��� �T
� �� � /lD G� �'ru.r�-iG �� � � ri
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Signeture ol euNOrized reCresenta6ve Addrass ot aNhwimO re0�ese�ta�ive (num0er aM s✓eet tiry, state, and LP code)
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