Age_PerryY° "+A. APPLICATION FOR SENIOR CITIZEN couNn � TOWNSHIP � YEAR i
,.,.. � PROPERTYTAXBENEFITS � (
Sbta Form d3708 (R919-08)
� � Prescnbed by Ne Depanmenl ol Local Govemment Finanw �
il M k
Informatiom m�tained in this doament is CONFIDENTIAL parsuant [o IC 6-7.1-12-9 ard IC 6-7.1-35-9. � - -
INSTRUCTIONS:
Utl, 1 0 20�8
To be filed in person or by mail wdh fhe CountyAUtlitor o/the county where fhe pioperty is located.
Filing Dafes: 7) Real Property: Dun� Ihe AveNe (12J mmt6s be/ore December 37 0/ fhe year fbe deducfion is to be effecilve.�J�"
2J Mobile Hanes ascessed urMer IC 6-7. 7-7 or manulactured hdnes not assesseU as real property: DunircJ �e fiD'erve,yr) months
be/ae Marrh 31 of fhe ear the deduc6on is fo be eHective. v
Y GIBS�H i:OUMTY AUDITOR
See reverse sitle 1a atldNionel instrvctions errd qualifications.
Type ot beneft repuested (daeso Meck a0 Naf epply)
�Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name of epolicaM (owrrer or conhact Evyo�
P
Is aoolimnt the sde legal or eQuitaWe wme�/ If No. whsl is hislFier exad share o: ir.teresl7 If owneE witF. wmaone otner Ihan soousa.
VICICd�B k'IIh W:IO.T.
�es ❑ No
R name on record is diRerent Nan thal ot aod���L indiwie bebw
Name ot con�2d seAer (eppl�itan! musf haw Ooon E�ying m con:racl at Mast orre (1) yoarj
Pdtl/B55 Of CpOb2d 501IBf (nUTEMdM 5'JCBI, Cify. StdlO, dnd ZIP COdO) �s Ne property in Uuestion:
� Real pmpe .ry � Mobile home (IC 6-14-n
�' 7y�ing Cistntl Key rum�er / Legal aewnotion I Record number Paye number
a�-la-b - � -oa
Is Ihe DroDBRy useC and OCCUp�eC pnmaeily bt Assassed value of ihe orooerty as ol March 1, wrrent year (may not ercoetl ">i82.a3C
nis�Ter residenm? br Over 65 Eotluctim, w£ 1fi0.000 for tho Over 65 Circud &oaker Cintl�1)
�Yes ❑ No
Was the aOD�Kan1 fi5 yaars of a9e w mwa on December 31 of ihe yaar
Have you fiiaE for aoy Wher deductions? If!ps. a�nat ceductior.s?
�Yes � No
Have you fied Iw ceduc4ons in any otner counry? If �s, wnat counry?
� Y25 �0
I/We certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resident
o( Indiana and owner of lhe a(orementioned property on March 1, 20 _
SgnaWre af avofirar.t AtlCress of ao0��nt (nvm6er ar,d sfinet, ci,y. s:ate. and ZIP code)
3/o HR �; // P; c N-r-oN 7� � v
� Spnatura of aut�onz re0resentaVV Mdress ot autharizeE rea�e tative (numberarrd s:reet, ciry, slate, anE LP cotlo)