HomeMy WebLinkAboutAge_Simmons"' APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR
PROPERTY TAX BENEFITS
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File �
Informetiom m�tafneE In this documeni is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC 61.7-359. J �
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INSTRUCTIONS:
To be fifed in person or 6y mail with fhe CountyAUditw o/ the wunty where the property is located. A P R 2� L �� �
Filing Dates: 1) Real Property: Dunrn� the fweNe (12J mwrths 6e/ore December 31 0/ the ysar the deduction is fo be eHective. �
2) Mobrle Hames assessed under IC & 1.1-7 or manufectured homes rrot assessed as real pioperfy: Du�the 1weA+ 2) months
v•r6�w rU�
belae Memh 37 0/ Ne year the deduction is to 6e eHective. �
See ieverse side kv additiona� insUVCtions end que�ificetrons. GIBSON COUNTY AUDITOR
Typa d heneft repueWetl (pleese rheck a0 fhat appl�� I
t er 65 DeducGon from Assessed Valuation er 65 Circuit Breaker Credit
Name of appGmM (ow�er a t bvyeQ
Ls aDO��m the sde lepal or epuitaMa rnxneR I( No, what is hisfier ezaG share w interest7 If owned with somerne oiher ihan soouse.
irWi�ate v�lh whom
❑ Yes ❑ No
I( name m recad is difla�e�H Man thal d epoGmn� IMicate Eelw ,
Nama o( controd tlar (applrcant musf hare Deon Wrylrp a� cmVad et least orre (1) yea�
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Add�ess of contra xller (numGOraM sbeet ay. sble. eM ZIPtoOe) Is the proDerty in puesi'ron:
property ❑ Mobile home QC 6-14-n
7y��� �in� Key numher I Legal descnotion RecoM numGar Paga numCar
� J �c�.� �G-1/-/�-a�.3-m3 �-oa-8
U Ne propery used enE occupieC pnmanly (or Assessed value ot ihe property as of Ma(ch 1, wrrer:t year (may not orceed 5182.a30
hiYher residence7 br Owr 65 tlotlucfion, a f f 60.000 lor �he Ovcr 65 Cucurt &oakor CmOi�
Yes ❑ No
V7as Ue aOW+�m 65 years of ape or more on December 31 N the year Apdkanfs
of death?
Adjusted gross ineome of applicant, spouse, and any Source of Inwma Amoum oi �ncome �
individuals sharing ownership (ForOver 65 deduction, income I S 1•_ 7J I
may not exceed 525,000; for the Over 65 Circuit Breaker Credit, ��
income may rrot exceed 530,000 for individuals, or 540,000 for S
married couples).
TOTAL I $ 0.00
r�.-a yw, r�ad ro� am aner eed�:t ir ves, .�mai ded�ao�:a
�Yes QN
Have you filed iw deEuU»ro in any otner coumy4 � Ir 1§s. what counry?
❑�5 �ryO
I/VJe certify under penalty of perjury lhat the above and foregoing information is irue and conect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Si9nature of ppfrartl Addrass of ep0����� (��Daand sbeet, city, sfate, erAZIP wde)
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Signatu�a d aum " reoresemative Addrasa otauthorized reo�esen iva (numbelaM sUOeG ciry, sta.e, antl LP codeJ