HomeMy WebLinkAboutAge_Nelson (3)APPLICATION FOR SENIOR CITIZEN (� \,�
- PROPERTY TAX BENEFITS I '�
Stam Fortn 43708 (R9 / 408) � �
��' ! P'esaibed by the Departmem of Laral Govemmem Financa `�
Infomiation wntelned in this dowment is CONFIDENTIAL pursuant to IC &7.1-72-9 and IC 61.135-9.
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INSTRUCTIONS: ��(/y ��+�i(J
To6efiledinperswioibymailwiUrfheCountyAuditwolthecountywherethepvopertyislocated. GIBSONCOUN�q�a70R
Filing Dates: 1J Reel Pmperty: Dunrg the fwelve (72) months be(ae December 37 o7fhe year the deduction is to be effective.
2J Mo6i/e Homes assessed urMer IC 6-1.1-7 ormanulactured homes nof assessed es reel piopeAy: Dunng Ihe fwehre (72) months
6e/ae Merch 31 of the year the deduction is to 6e e/fective. .
See reverse side !w add'dional insWdions arM qualificetims. '
Type N beneft �uested (p/aaa6 Mack e➢ Nat apply)
❑ Over 65 DeducGon from Assessed
(
❑ Yes ❑ No I
It name on �ecad ia diftareM ihan tlwt o(apd'zan4 i�diwte 6ebw
Nama of cariraU saAer (eppl�canf musf have Deen buying an canVaa af leasf orre (1) yearj
PdC(ass
abee4 �: spte, aritl ZIP cada)
Keynum6er/
i y .' _
45 the WopeM use0 aM occupied oriman br
hivhar rasidenm7
� Yes ❑ No
Was tha a0a��165 yea�s of ege or rtrore on Decemear 31 01 the year
orior to Ne artaM yean
�Yes ❑ No
Adjusted gross ineome of applicant, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not exceed 525,000: 7or the Over 65 Circuit Breaker Credif,
income may rrot exceed $30,000 (or individuals, or 540,000 for
married couples).
olherdeducEOns7
� Yes
Have you filed for Eeductions in any other muMy9
� YBS
� No
,� •
� Over 65 Circuit Breaker Credit
winiB�esl?
It ovmeC vnth sornaona Wher lhan spouse,
indifate with whom
Is tna D�oaM �n Qu95tron:
eal property � Mobile home (IC 6-7-1-�
i Record number Pa9e number
� 7 �-Ob 'J�'. —0 oi.�-
AssesseE value of Ihe wovem/ as ot March 7, cuRem year (may rat ercee0 5182,a30
for O�er 65 deduc(ion. or 5760.000 !or Ne Oror 65 Circurt Breakei GeQit)
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IIVJe certify under penalty of peryury that the above and foregoing information is true and cortecl and that lhe applicanf was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
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�;�/.�..o�% �/l�A�.., -L ����.rf����s �- 2� � �
d eWhaized
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eulhonmd repReBnietive (num6erarW suee4 ciry, sfafo, an0