Age_TurnerAPPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
` '�• SbteFortn43708(R9/9-08)
� Presuibed by the Deoartmertl ol Local Govammem Finance
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Infortnation containetl in this tlocument is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.135-9.
INSTRUCTIONS:
� O W I YEAR
JAN 2 2010
� � 6ile Mark
N�.
U
GIBSON COUNTY AUDITOR
To be filetl in person oi by mail with flre CountyA�tlrtw o1 the county whera fhe property is located.
Fding Dafes: 1J Real Property: Dunry the tweNe (72) mwdhs be/ae Decem6er 37 0/ the year ths deduction is to be eHective.
2) MobNe Homes essessed uMei IC 67. 7-7 or manufacturetl hwnes rrot assessed as reel property: Dunrg tAe hveAre (72) months
be(we Mardr 37 0/ fhe yeer the tleducOOn !s to be eflactive.
See reverse side lar edd�tionallnsWdions erni qualfications.
Type of benePo rapuested (p/ease rheck e0 Nal apply)
❑ Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name oI avW�wm (ow.rer a cmvaa Duye� �
U epplitaM the sda lapal oreQu e eR It No, wtiat ia hisRiar ezad share w inieresl? I( owned wiih someone dher Ihan spouse,
inditata wit� wtiom
es ❑ No
M name on record is diRerant than Ihat d aod��l ��diwta belav
Name ot mrt2d seller (appliwnf musf heve bocn buying an cmt2c! at bnsf oria (1f yeah
Pddresa d wntraG seDar (n�m0or xM s0ae; ciy, sble, aM ZIP wEe) �s the proDerty in Vue5ti0n:
al pmperty � Mobile home (IC 6-7-7-n
Tuing ' d ' Key number I Legal descn0�ion Record numbar Page numbar
�o- - -ZD -Lbd-.l - . 02-�
la Ue p(operiy used eM occupied wimarily br Assessed value of the DroGerry as of March 7, wrtent year (may not exceed SiH1.a30
tdaRier res'Mence) 1o�O�er 65 tlotl�rlion, m 5760.000lor Ne Wa 65 CircuR 8roakar Ciedif)
❑ Yes ❑ No
Waa the epplicaM 65 yean ot ape or more on Decem6er 37 of ihe year App�imnt's dale of birih (mmN. day, yoaQ If filed by e surviving. unmartied spouse,
prior lo the arteM yeaR . what was lha spouse's age et the time
� Yes ❑ No . o�d�ma
Adjuated gross income of appliwn; spouse, and any
Hava you Nad for arry othw deductione7 �f 1§s, what deductionsT
� Yes ❑ No
Have you filed tor deOucGOns in eny other caurity7 If les, whaf counry? �
� Ye5 ❑ No
IIWe certify under penalty of perjury that lhe above and foregoing infortnation is Irue and wRect and that the appficant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
Signature d appikartl AdErasa of aDP�i�r.t (numDOr aiW sboel. ciry, sfafe, arM Z/P wtle)
, ��-- /oS�/. .�.�oX733 � �
Sipnafura of auth ed �aD�sentative Pddresa of aNhonzed repraseniative (numberaM s:+aet. ciry, sfa:e, and LPcode)