HomeMy WebLinkAboutAge_StollAPPLICATION FOR SENIOR CITIZEN �j ouH - o HIP � YEAR i
. PROPERTY TAX BENEFITS j
Sfate Fortn 43708 (R9 / 4-08)
�, ��� '� Prescribed by the �epartmeM of Local GovemmeM Finance
File Mark
Intwmatam m�tained in this daament is CONFIDENTIAL pursuant to IC E1.1-12-9 and IC G1.1-35-9.
INSTRUCTIONS: �� ' a�'
To be filed fn person or by mail with the CountyAUtl'rtw o/ the wunty where the property is locafed. G IBSON COUNTY AUDITOR
Filing Oafes: 7) fteel Pioperty: Dunrrg the fweNe (72) marths before December 37 of the year the deduction is to 6e eRective.
2J Mo6ile Homes essessed urMer IC fi7.7-7 ormanulacturetl homes not assessed as real property: Dunng the txsNe (f2) months
6e/ore March 31 0/ the year the deduction is to 6e eHective.
See reverse side /oradditional insWUions arM qualificetions.
Type d benefit reQUested (yea5e rhack a0 Naf appry�
� Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name
ovmeR H No. what is hisfiar exad s ara or interest? - H owned with wmeona other lhan spouse,
indipte with whom
❑ Yes ❑ No
H name on racrord is diflerem than that d apWiwnt, indiwte balow
Name of comrzd seller (appliranf must hava been buyirg on confract at leasf oire (7) yea�
Pddrass of mnirad seller (num6eraM sbeel, cM. sWfe, anE ZIP wde) Is ina omoeM in Question:
eal pmperty � Mobile home (IC 6-74-�
� T�ing disind Key number I legal descnption Record numCer Paga num6er
- "Q7 % �
Is ihe pmpeM1y use0 and occupiad primariy for
Have yw filed tw aery other detluetions? If Yes, what deduetions?
� Yes � No
Have you filed tor deducUOns in any other coumy7 If 14s, what counry?
❑ Yes � No
I1VJe certify under penalry of perjury lhat �he above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
' natu aOW�M , Ptldrass of aOD��m�� (numbarand stroct. ciry, stafe, aiM ZIP code)
�1�� � �'�y �` �n:� ��.. , ��G-��
� Signature ot a�horized reo�esaMafiva Address o(aulhwizad reo�sa�ta�ive (num0er d sbeef, ciry, stata, and L code)
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