HomeMy WebLinkAboutAge_Altmeyer"'" APPLICATION FOR SENIOR CITIZEN
: PROPERTY TAX BENEFITS
Stale Fwm 43]OB (R9 / 9-08)
•� � Presaibed by Ihe Depanmem of Loral Go�emmeM Finance
Infortnatlom m�tained in lhis doament is CONFIDENTIAL pursuanl to IC 61.1-12-9 and IC &1.1-359.
COUNTY TOWNSHIP YEAR
Fle Mark
INSTRUC710NS:
To be filed in person oi by maii with (he CounfyAuditor of the county where the proparty is locafed.
Filiry Dates: 1) Real Property. Durng fhe fweNe (12) mmlhs 6e/ae December 31 0/ the year the '`p�^ 6e
2) Mo6ile Homes assessetl urMer IC 61. 7-7 0� manulactured homes rqt assessetl e I p peyy.� Du e (72) mmfhs
bePora March 37 of the year the deduction is to 6e eflective. 1U
See reverse side !or add"Aional insWClions arM qualifications.
Typa d benaft requastad (p'ease rh fhat apy�
er 65 Deduciion Bom Assessed Valuation ❑ Over 65 Circuil�re�.
Name d epp&am (awner or carrtiact buye�
GIBSON COUNTY AUDITOR
Is applim lhe sde lagal oreQuilabl eR I(NO, what u his/n zact share w interast7 II owned wiih someone othar Ihan spoum,
'uMirata wilh wnom
Yes ❑ No
If nama on remd'u dilfarerit Ihan Ihal of epplimnt, i�irate bebw
Name d cmtad se�er (app/'rcant musf hare been b�ry"ug m cmtrad at basf orre (i) yea�
Pddresa ot mntraU mller (nunber aM sbeeL �+ry. sble. ard LP wde) Is iha property in estirn:
eal property ❑ Mobile home QC &14-�
iazing d�stricl Key number / Lepal deznplian Record number PaSe number
a6 - - -303�-� 13 �da�
Is Ne poperfy used aM ocwpied primaay for Assessed value ot the property az ot Ma`ch 7, rurtant year (may imf eiwed f182,430
hislnar resiEanml !or O�er 65 dedudion, � 5760.000 Por No Over 65 Cirnuf Bmaker CrediQ
es ❑ No
Was lhe eDW�^� 65 years of ege or mwe on December 3 of ihe yaar Applimnl' yaarJ If fileE by a surviving, unrtertied spouse.
qior to Ne a�rteM yeaR ❑ ��_�_�� �� �s the spouse's aBe al the time
Y95 No otdeath?
Adjusted gross income of appliwnt, spouse, and any Source of Inwme Amount of Income
individuals sharing ownership (ForOver 65 deduction, income S
may not exceed $25,000; for fhe Over 65 Circuit Breaker Credif,
income may not exceed 530, 000 ior indivrduals, or 540,000 for $
married couples).
TOTAL 5 0.00
Have you (Jed tu a�ry other datlucbons7 If 14s. what dedudiorts7
� Yes ❑ No
Have yau fueE iv deductions in any ather cwnry7 1114s, what wuMy7
� Yes ❑ No
I/We certify under penalty of pe�ury that the above and foregoing information is We and covect and ihat ihe applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20
Signature of app�xam Addrass ot app6mnl (nianboran0 sboeL aty, sbM, andZlPmOe)
�° 'a O 4. �`an�.e.
tu dauU�wizedrepraserttative Addressofaulhwizetlrepresentative (num6vraMS4oef,city,slate.endLPCada)