HomeMy WebLinkAboutAge_Zollars"' v APPLICATION FOR SENIOR CITIZEN
r� -. - - PROPERTY TAX BENEFITS
•S J Sfata Fortn 43708 (R9 / 9-OB)
Prascn6etl by ihe DepaNmeM of Loral Govemmer�t Finance
Information contained in this documenl is CONFIDENTIAL pursuant to IC G1.1-12-9 and IC 61.1-35-9.
INSTRUC710N5:
COUNTY TOWNSHIP YEAR
�� F���
To 6e filed in person or by maii with fhe CountyAuditor ol (he county where fhe {voperty is locatetl.
Filiry Dates: i) Real Property.� Dunrg the tweAre (72) makhs before December 37 07 fhe yeai the deduction is to 6e e9 1 R ,(��%
2) Mobile Hwnes assessed urMer IC frf.1-7 or manulactured homes rrof assessed as �eel property.� Duriry�hsseNB (12)'MOnths
Defqe MaTll 31 Of NB yBer71B 09OUttlon IS to DB BrteCOVe. C�
See iaverse side for atltldional inshudions alM qua!"dicatlans
rypeNbenefirequested(peasad�eckaumatappay) GIBSON COUNTY AUDITOR
er 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name d appGCa�n ( or cmtract Duye� /�
�[� (-)L���
Is applimrit ihe sola lagal or eQ�itaNa owneR I( No, �s/Aer esaG share or inlerest7 H owned with somema oihet ihan spoum,
indipte vrtth wtnm
❑ Yes ❑ No
If name on rewrd is diflarant ihan tlial of appfrcant, iiWirate below
Name of contrad se0er (applrcanf musl Aava been biry'ux� m conlydcf af bast orre (if yeaQ
Pddress d cantraU mller (number aM sbee4 �: sb�, aM LP wde) Is Iha pmpery in quesiion:
eal pmperty � Mobile home QC 6-74-�
T�inp Ei rin Key numher/ Legal description Record numbar Page number
C / -/ - - Q f,Q
Is Ne poperty used aM ocwpied primarily b Assessed valua of tha pmpafty as of Maml� 1, curtaM year (may irof excmE SiB2,d30
hisRiar residence7 (or O�er 65 datludion, ar 5760,000 /or the Over 65 Ci�cuif &eaker Credi�
❑ Yes ❑ No
Was tha apqiraM 65 yaars af age a mwe on December 31 of Ihe year Applimnfs date ot birth (manfh, Eay, yearJ I( filed by a surviving, unrtartied spouse,
prior ro Ihe a�rtaN yea(7 what was ihe spousa's age at ihe t'une
❑�s ❑No �,
Amourrt o1 Income
individuals sharing ownership (ForOver 65 deduttion, income $
may not exceed 525,000; (or the Over 65 Circuit B2aker Credif,
intome may rrot ezceed 530, 000 for individuals, or 540,000 fw �
married couples).
TOTAL $ G 0.00
Flave you filad tor any ofher deductions9 If Yes, what deductionsl
' � Yes ❑ No
Hava yw filetl lor deduc�ions in any olher county? If Ws, what couMy?
� Yes ❑ No
IIWe certify under penalty of perjury that the above and fo�egoing information is true and correcl and that the applicant was a resident
o( Indiana and owner of the aforemenlioned property on March 1, 20 .
Signature appGcant ^ Mdress of appfimnl (mmberaM sboel, cify. sbto. arM ZIP wde)
V'v� �
Signature d authorfzed rep�ese .na Atldrass ot authorrzad reprasantative (nvnberandsfineL a7: ��a, ana LPCOOe)