HomeMy WebLinkAboutAge_Rainey:•"' p� APPLICATION FOR SENIOR CITIZEN �� I coururv � TOWNSHIP � renn i
,... � PROPERTY TAX BENEFITS I
� ` �'• Sbte Fortn d3708 (R91408)
Prasaibed by the DapanmaM of Local Govammem Finance ��
� Fi M
Infortnetiom m�tained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.1-35-9. '
INSTRUCTIONS:
DE(; 1 0 2008
To be filed in persm or by mail witA the CountyAUditw ol the county where the property is located.
Filing Dates: i) Real Property: Dunng the hveNe (72J monfhs belae Decem6ei 37 0l the yea� Ihe tleducP� /�/� to 6e! �.
2) Mobile Hanes assessed under IC 64.7-7 or manufactured homes not assessed as real piop�Dumig� � twaNe (72) montlis
belore Mardr 37 o7the yearthe deduc6on is to be eHective. GIBSON COUNTY AUDITOR
See reverse side /Or adtlitional insWdions e� qualificaUOns.
TyOe o1 beneN repuested (ploato Meck aH Nat aOP�
QOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name oticaM (owrier or cmtrdct OyoQ �
� �
Is aDPNmm Lhe sde legal or eQUitabie ovmaR If No, what is hislner exact 5`a:a w ir.t re If Qwned vnih someone othar Ihan spouse,
inditate wi�h whom
Yes ❑ No
It name on record is ditFerem Ihan ihat ot eod��l inCicata bebw
Name of miitad sePar applicant most have Seen Guyirg on crosdct at /oast oim (f) yea�
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Pdd(ass of mntrad sel r(numDer aM sbeet, ciry, sta[e, aM ZIP code) �s the orooarry in cueslion:
� Real pmperty � Mobile home QC 644-n
Wcing tlistAct Key numher / Lagal descnption I Record n�m6er Page numbar
G¢,P,w�.,..�� a�-�y-a7-aco-.ono.�sr�
Is �he properry used anc occuoied cdmany for Assessed value of tSe Drooerty as of Ma¢h t, cur.er,t year (may nof exceed S1H2.a30
hisRier resiEence7 for O�er 65 doduGion, w S f 60.000 hr the Ovoi 65 Cirnn: &oaker CrediQ
Yes ❑ No
Was the aoW�caM 65 years of age or more on Decembar 31 Ihe year
Have you (led for ar.y othar deCUCtions7 IF ves, w:ha� deductiors?
� Yes Q No
Hava you fded tw EaCUClions in any other counry? If �gs, woat counry?
� Yes No
IIWe certity under penalty of perjury that the above and foregoing information is true and correU and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 '
Signalure af apd�m PECress of apDlitar.t (number antl sVOef. ci,y, sate. aM ZIP code)
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Signalure of authonzad represemative Address of authorized reorasentahva (numDeland s:meq ary, sfaro, and LPcode)
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