HomeMy WebLinkAboutAge_Meeks" APPIICATION FOR SENIOR CITIZEN
r . .. - , PROPERTY TAX BENEFITS
State Form 43708 (R9 / 9-08)
�� u� � Prescnbad by iha OepartmeM of Local Go�emmem Finance
Infwmation wntained in this dowment is CONFIDEN7IAL pursuant to IC 6-1.1-12-9 and IC G7.7-359.
INSTRUCTIONS:
COUNN TOWNSHIP � �iEAR
I
ile
JUN 9- 2011
To be filee in person or by meil with the CountyAutlifor of the wunty wheie the property is locatetl. �
Filing Dates: 1) Real P�ope�fy: Dunrn� the fweNe (12) months 6e/ae Decem6ar 37 0/ the ysar the deduction is fo be elfec '.
2) Mobile Hanes assessed urMer IC fi1.7J o� manulactured homes rrot assessed as real property: Dunng the twe 2 nfhs
belae Merdi 37 o/tAe yeerthe deductlon is to 6e etlective. G�BSON COUNTY AUDITOR
See ieverse side la additional insWUions and qualificefions.
Type W beneN reduested ({Jease rheck a9 Naf appfj�
� Over 65 Deduction 6om Assessed Valuation � Over 65 Circuit Breaker Credit
Name of apOfitam (Owne✓ cv Conbect Euy/B�
• ' /
Is aopliaM Ne aole legal or epuilaMe owne(! If No, what is hisRier exaG share or imerest7 tl awned wlth swneone mher than soa:se.
InEirata wiih wtwm
❑ Yes ❑ No
tt name on taco�d (s difta�eM Man Ihal d aod'��t indicete bebw
Name of amraa seller (app/icanf musf Aew beon Duyirp on con(ract al bes! orre (7) yoarJ
Addtass W mntratl selier (numbaaM abeoC tiy. SWb, e/M ZIP m0e) �s the D�oeM in Question:
Real property � Mobile home (IC 64-7-�
� Tazing dislncl Key numbeN Legal descriptioa RecorO numCar Page num6er
i 2- - o om o$ oa
U Ne pmoeM used end occupied pnmaNy br I 0.ssassed value ot the o�ooerry as at March 7, current year (may nof erceed 51H2.d7p
hisrt�er resitler.cs? lor O�er 65 tlotlurlion, w 5760.000 /or Ne Ove� 65 Circ�if Breakar Cradifj
Yes ❑ No
VJas lhe apo�Ca�165 yean of age or mora an Decamber 31 of the year
�
Fiave you filed M aery other dadud'ans9 If Ws, what deductionsl
� Yes ❑ No 5' .
Have you filatl M deductions in eny other cou�rty7 If Yes, what munryl
� Yes � No
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and wrrect and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20
se���reotaco�wm ndaressoreoo�m (numbeia�dstroel.ciry,slafe.aM2/Pcotle)
�./,E; �. 7G%O
� Signature ot authaized �e0�semative Addrass of aulhoAZed re0�sentatrve (num0eraiM suoot, �ty. sta;e, anE LP catle)