Age_Lynch:
" rt� P APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
�State Fwm 43]08 (R9 / 408)
��• Prescnhad by the Depa�ment of Loral Go�emmem Firance
�
Informatiom m�tained in this tlowment is CONFIDENTIAL pursuant to IC 6-1.7-12-9 and IC G1.1-35-9.
COUNTY I TOWNSMIP I YEAR
INSTRUCTIONS: pEC �
To 6e filed in person or by mail with the CountyAuditw oJtAe county where the property is Ixated. � j' l Q��
FAing Dates: 7J Real Property.' Dudrg Ne tweNe (12J months be(ore Decembei 31 07 the }aar the deduction is fo be effective.
2) Mobile Homes assessed under IC 67.1-7 or manufactured hwnes not assessed as �eal properfy.'��he tNS/ve (72J months
O ,�,:":-"
be(we March 37 o)the yearthe deduction is to be eHactive. GIBSON COUliTV ✓ F�k
See reverse side fa etltlitional instrudions end qualificafions. �Upi�i
Typa d beneN repuestetl (ploese Meck a➢Nat appry)
❑ Over 65 Deduction 6om Assessed Valuation
Name d apolicaM (owrrer or contract Du�Q � /�
Is 800���i lhe w!B
It name on rerad is
Name W mnzd sa
Pddrass of cortraU
� Tax disinci
(
Is Ihe pmpeM used
hisfierrasiden�»7
? � ❑ "° I
ihan ihat ot aodicanl �ndiwte bebw
0
axatt shara or ir.terest9
Evyirg on cm'vact at /oast orre (i) yea�
(numDM anC sbaol. city. SWIe, antl ZIP wdo)
o�many br
legal descriMion
�Yes ❑ No
JJas the aDM�m 65 years of a8e or more on D m er 31 of the year
�Mrlo ttia cLrram yeaR
Yes ❑ No
Adjusted gross income of appliw spouse, and any
Individuals sharing ownership (FO�Over 65 deduction, income
may not exceed S25,000; Ior the Over 65 Circuit Breaker Credit.
income may not exceed 530,000 for individuals, o� 540,000 for
married couples).
Have you filed tor any Wher dedunior.s9
Mave you (dec (w tletlucCOns in any other
Yes � No
� Yes � No
65 Cirwit Breaker Credit
If owned
IndiCate'
Is iha omoaM �n duestion:
soouse,
Real pmperry � Mobile home (IC 64-7-�
cord number Page r.umber
�'�•LL_l�l O/l/� � �v� o
0.ssessed valua of the omoerty as of March 1, curtent year (may not ercceE 57H2.a30
!or O�cr 65 tlotluUion. a 5160.000 lor Iho Ovor 65 Ci2ui7 &caker Cmdit)
If Ves, what Ceductiors?
�-iS �,��% �,
If Yas, wnzt counry? �
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
ot Indiana and owner of the aforementioned property on March 1. 20
Spn W eD �m MOrass of aoplimn� (numberand svicef, ci.y, sfare. arM ZIP codc) '�'
�
,�' � , ' r, , 5S � � N � so � P,����r .�,✓ y���
Sgnature da 'zed ra esentative ( dress af authorized raorasentativa (numbMand s:loe(. ciry. sfa:o. and LP code)