HomeMy WebLinkAboutAge_Williams (9);. A
APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
Stab Fortn 4370H (R9 / 9-OB)
� � � Prasuibed by tl�e DepaR+ner� af Local Govemmerrt FNarrca
�
�,
Intormation wntained in Ihis dowment is CONFIDENTIAL pursuant W IC 6-7.1-72-9 and IC E1.135-9.
INSTRUCTIONS:
COUNTY TOWNSHIP YEAR
JUN 2 2 2009
To be fi/e0ln persm or by mail wifh (he CountyAudita o1 the couny whera the property is located.
Filiiy Deles: 7J Reel Property: Dunng the fwelve (72) martths be/ae December 31 o/fhe ysar the deduction is to be e�"�' ��
2J Mobile Hanes assessed uiMer IC G7.7-7 or manu/ecturetl homes rrof essessed as real property� Dunng the t�elve (72�ionNs
be/ae Ma�d+ 37 0! fhe yenr the deductlon is to be eHective.
GIBSON COUNTY AUDITOR
See raverse side lor atltldional insWcfions arM qualifications.
Type d beneft repuesied (pJeate Mxk a0 Nal app/y)
❑ Over 65 Deduction 6om Assessed yaluaEon N I Over 65 Circuit Breaker Credit
'T
Name af appl'xanl (owrier a cant�acf DvyeQ
// ' '
Is eoP�uarrt the sole lepal or eQUica0le ow�neR H No. whet is hiaRier e:act share or interast7 K owned with swneone mher than spouse.
indipte vnth whom
� Yes ❑ No
H name on (emitl is diflarerrt than Mat d apo6cant iM'r.ete belvw
Name d coM2p se0er (epplicenf must hare beon buyirp m cmvacf af /easf oire (1) yea�
Address U mntrad seVer (numbm aM sbeet ciry, s1ale, eM ZIP code) Is the o�Perty in Quest'pn:
Real property � MoDile homa (IC 6-1-1-�
� 7az{ng Elstocl Key numbar / Legal de�oa oaa. �a Record number Page number
G i/ �� � ��
U Ihe pmpeM used aM oaupeC pnmaiy for Assessed value of the D�oDeM as at March t, curtent year (may rrof erceed 5182.d30
his�her resideno? hrO�er 65 tletlucliun. m 5760,000 !or Ne Over 65 Circait Broakai Gedin
� Yes ❑ No
Wa� �Aa epWiprit 65 yean ot ege w rtrore on Decamber 31 01 the year
Nave you filed for arry olhar deducCUis7 If Yas. wtat deductions?
� Yes ❑ No
Nave you filed for deEuctiona in any dher couMy? I(1gs, what coufrty?
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing information is frue and cortect and that the applicant was a reside,�t
of Indiana and owner of lhe aforementioned property on March 1. 20
$Ignelura of aPP�^� � Mdress of epplimnt (numba aiM sboel. city, sWte. arM ZIP code) . .
� \
�./.� 2r981,J C(I /�oS' Pi?iNCrroN /�/ y7
� Sipnature d auLhwized representative Addrass of authonzad rewesentative (numbm aM sbooc, ciry, stafe. an0 LP coQo) �