HomeMy WebLinkAboutAge_Lanman� APPLICATION FOR SENIOR CITIZEN �ouNn TOWNSHIP � YEAR j
' PROPERTY TAX BENEFITS
h �' � State Fortn d3708 (R9 / 9-08)
�.,. Prescnbe0 by ihe DepaNment of Local Govam:neM Finanta i'f �
Fil ar
In`ormation wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
G\
�
iNSrRUCnoNS: DEC 1 1 2008
To 6e filed in person or by mail witb tha CounryAudifor of the counry where fhe properfy is /ocated.
Filiry Dafes: 7) Real Property: Duniy the fweNe (72J months be/ore Oecember 31 0/ the }rear the tleduction is fo be eHe�ctivNe.
2J Mobi(e Hanes assessed under IC 6-7.7-7 ormanulactured hwnes rrol assessed as real prop��uqng�r�eaw�Na (72) months
belore March 37 o/the yearfhe detluclion is to be eNecfive. �l
Seereversesitletwadditionalinstrudionsa�qualifica6ons. GIBSON COUIdTY AUDITOR
Tyoe of benaf.t rapuestad (d�eso tlieck aB Naf apply)
❑ Over 65 Deduction hom Assessed Valuafion ❑ Over 65 Circuit Breaker Credit
Nameo(epdicar�t a✓contracfE�yo� �
is aoplimnt the sola I al or eQUitaWe 1( No, whai is l,",er exad share cr interesl? If owned vnih someone other than soousa,
indinte wit� w:.om
. Yes ❑ No
If name an record fs �iRerent Nan Mat ot aod��L ��diwte bebw
Name of cont2 seDer (epqicant musl Aava been Ouy'up m cart'uau af least orre (1) ycarj
a
Pddrass of d selier (number arW sbaet �+�y, sbW, eM ZIP mde) Is ine omoeery in auestian:
� Real Dmpery � Mobile home pC 6-iJ-�
Tazing dislnct� Key number / legal tlescnplion I Record number Page numoe�
�� - � �- 32� -p oa.�f b6��
Is ihe propeM used and oavpied o�many for I Assassed value of the Woperiy as of Ma¢h 1, cunant year (may iwt exceed S1B7 a30
h19RIBf �B9idB�CB? !or Oeer 65 EoCUCfion. w 5160.000 /or t�a Ovei 65 Circuil &eaker Ciodi:)
❑ Yes ❑'rio
Was tha apWkzM 65 yean ot a5e w mae on DecamCer 3t of tne year
Have you (led fw any olher deductions7 If Yes. what dedu br.sT
� Q No
Have you filad (or ded�ctions in any othar counry? If `§s, wnat cou:�ry?
� Yes No
I/We certify under penalty of perjury lhat the above and foregoing information is We and correcl and that the applicant was a resident
of Indiana and owner of the a(orementioned property on March 1, 2D
Signature W aDO��� AEdress of aooiimr.i (r,umber antl sveei. ci.y. siam. aM ZIP cotle)
�� �
Signatura W a �zed reDresentati � Address of euthorized reoresentative (nvmborand stme(. ciry, slate, anE ZIP code)
�,2 0� "