Age_Richeson"'" APPLICATION FOR SENIOR CITIZEN COUNTV TOWNSHIP ve�ui
PROPERTY TAX BENEFITS
S ''• SbleFortn437081R9/9-08)
Prasclibad try Ne Departmenl ot Local Govammem Finance
de
IMormatiom m�tained in this document is CONFIDEML4L pursuant to IC 6-1.1-12-9 and IC 61.1-35-9.
INSTRUCTIONS: O
To be filed in person or 6y mail with the CountyAud"dor o7 the county where tl�e property is locatetl. � E C � d � Q � 2
Filing Dates: 1J Real P�operty: Dunng the fweNe (72J months be/ore Decem6er 31 0! fhe ysar the tleducfion is to be e[fl�ec��
2) Mo6ile Hanes assessed urMer IC 6-7. 7-7 or manu/acturetl hanes not assessed as reel property: Dumg i��Si�� - V!hs
belwe Maa� 37 ollhe yeer fhe rletlucSUn is fo 6e e/fective.
See �everse side !or additional inshuctions aml qualifications. G I BSON CO UNTY AU D ITOR
Type of beneft �epue5ad (ploase rheck eH Nat appl�
� Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Namao( " M(awrrerorcrontracfDuys� �
Is appli lhe sde lega or epuitabla ownafl tl o, what is his/her ezatl share w interesll It owned wilh sameone alher ihan spousa,
iMiote with wham
❑ Yes ❑ No
H name on record'u diRarent than that ot a0d�mnt indicale bebw
Name al conlrza seller (appicant mus! ha�e been buy'ug m cmfract a� leasf olro (7J yeaQ
Addfesa d wntraq mller (num6er arM stree4 uN, sWk, aibTJP mEO) Is ihe P�Pefty in 9uesiion:
eal property � Mobile home (!C fi7-1-�
Taxi� d'ai+id Kay num6er / Legal desuiptian Record numbar PaBe number
� �-� -��-�vy-o�. 9a � oa�
Ls Ne popery used and ocwped � rily br Aueaed value of the pfoperry as of Marrh 7, aRent year (may iwf exceed 5182,430
his/hqf razidancay IorO�er 65 d¢duUbn, or 5760.000 (or Ne O�ar 65 Cuaut &ealmr Cred'�
es ❑ No
Was the appfrarit 65 yaars af ege a mae on Oacember 31 of the year
Hava youlJed for afry other detluctionsl If 1§s, what ded�ctionsl
� Yes ❑ No
Have you filatl far detluctions in any olher wunty7 Ii 14s, what cou�!
� Yes ❑ No
VWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and lhat tha applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signatura d ap M Address of applimnt (numberantl s6eeL ury. sAfa. arrtl ZIP mda)
/ � � / �
Sig u d onzad repras Pddress of aWhwized re0����ina (nu 6a arN s f, cify, steta, and ZIP e)