Age_SlinkerAPPLICATION FOR SENIOR CITIZEN couNn TOWNSMIP renR
PROPERTY TAX BENEFITS
� Slale Fortn 43708 (R9 / 9-08)
•O o�. � Prescnbed by Ihe Daparimenl of Local Govemment Finance
e Mark
Informatiam m�tained in this tlowment is CONFIDENTIAL pursuant to IC 6-1.7-12-9 antl IC 61.1- 9. I
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INS7RUCT70NS:
To be filed in person or by mail with the CountyAuditw of fhe oounty where the properiy is locafed. S E P 2 9 2� � �
Filing Dafes: 7) Reel PropeRy: Dunng the fweNe (72) months 6e/ora December 31 olthe year the ded 6on is t 6e eftective.
2) Mo6ife Hwnes assessed undeNC 6L 7-7 or manNactured hanes rrot auessed as rCe�mpe . fhe AvaNe (72) monNs
be/we Marrh 31 0! the year the tletluctron is to 6e e/Iective. v
SeereversesidelaatltlitionalinsWUionsandqualificafions GIBSON COUNTY AUDITOR
ryae m eenec� reaues�ed I�+ease r�e� ec rna� eapN
❑ Over 65 Deduction hom Assessed Valuation Over 65 Circuit Breaker Credit
Name dapqicart (owrmrarcanfradWyeQ �
�d -�
Is appGar�t Ne sde legal or equrtada wme(! It No, what is his�har ezad s e interest7 If amed xiN swname olher lhan spousa,
indit2ta vr�h whom
�, Yes ❑ No
If name on record is diReeem Ihan Ihat af appGcanl iMicata babw
Name of mntrar2 seller (a t must have beon buyirg m cantract af IoaY orw (i) yearJ
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Pddress d wntrarl mller (n er aM sneeG rJry, sfab, eM LP wde) Is the pmperty in question:
� Real pmperty � Mo�ile homa (IC 6-14-�
7ywg � Keynumber/Lepaldascn0�� Remrdnumber Pagenumber
� a�-��.��-��-�5� s
Is ihe pmpery used and acwpieE primany lor Assessed value of lha pmPe`ty as of Marrh 1, aRent year (may irof axmed f782.430
hisrher resiAenm7 (oi Orer 65 dedudion, u� Ef60.000IUr Ne Over 65 Circuit &eakar Crotl�
ve5 ❑ No g
VJas iha appfxam 65 years of aga or rtrore on December 31 d lhe year
�e yrn, raea tar am� rnner aeaucca,sa u�ss, wrw� ded�o�?
Yes Q'No
Hava you filed for deductions in any other coumy7 tl 1§s, whal coumy!
❑ Yes ❑ No
I/We cerlify under penalty of pe�ury lhat the above and foregoing informalion is true and correct and that the applicant was a resident
of Indiana and owner of ihe aforementioned property on March 1, 20 _
Signatura Addressofappfirant (nvnberaridsbee4�Y.��.�ZlPcode)
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Signalure authorizetlre �a Addressotau(horim reprasentative umbrlandsGOeL�:state,andLPcode)