HomeMy WebLinkAboutAge_Allen"'". APPLICATION FOR SENIOR CITIZEN
: PROPERTY TAX BENEFITS
'S �... ! Slafa Form 43708 (R919-08)
Preulibed by �he Oapartmem of Local Go�emmefn Finance
COUNTY TOWNSHIP YEAR
Fle Mark
Infortnatiom m�tained in this Uoa�ment is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC 61.b3S9.
�NSrnucnoNS: DULY ENTERED FOR TAXAT��N
robanadr��,�orbyma�i�mmeco�Mya�dnoroi�,eco��rywne.��ep�openyrsioca�ad. Sub.e��o{i�alacceptanceforiransfer
Filing Dates: 7J Real Property.' Dunng fhe tweNe (12) mmths befae December 37 0/ the year fhe d�tiOn i b4 ba e//ective. —�—
2) Mobile Momes essessed urMer IC 6-1.1-7 ormanu/actureO homes rro( assessed essaeFp��rty: un the Iwslve (72) monfhs
6efae Marrh 31 o(fhe yea� the tletlucfion is lo be eRective. `+ � r��,��LY� AU�itOr
See reverse sitle for atlditionel inshudions entl qualifications. ��� C� Gibson County
a! Nai app/�
65 Deduction from Assessed Valuation
Name d applicant (aw�rer or canlydcf
Is app6mM lhe sde lepal
�Yes ❑ No
H name on racard �s diflerant lhan ihat of aPd�nt ini
Name N cmtacl seDet
�
orie (f)1'ead
m
q 2i
er 65 Qr��t �r er redil
Pddrass d conbatl seller (num6er aM sbeef, city, state, aM LP mCe) �s
Ta�cinp d'atrin Key number / Lepal descnption
� �(J /V �V.iv � M/V K/��
Is the propefly used and xwpiea primariy for Assessed value ot the ort
hisTher rasiEanca7 torO�er 65 Oedurlian, ar
❑ Yes ❑ No
aga or mora on December 31 d ihe year
❑ Yes ❑ No
Adjusted gross income of appliwnt, spouse, and any
individuals sharing ownership (FOrOver &5 deduction, income
maynof exceed $25,000; (orthe Over65Circuit 62akerCredit,
income may rrof exceed 830,000 for individuals, or 540,000 for
married couples).
Have you (dad tor
� Yes ❑ No
Have yvu filad tor detlucCOre in any oUter munry7
� Yes � No
H ovmatl with mmeana othar lhan spause.
iMiwta wi�h whom
a pioperty in pues�ion:
� Real pmperty � Mobile homa QC 614-�
VWe certify under penally of perjury that the above and foregoing infortnation is W e and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature ot appfram
ofauthonzed
Addrass ot apolimnt (niun0oraid sboof, city, atate, erd LP mde)
�OQ /lJ l.�t�.at '�t � •
Adtlressofauthw�drav�����e (nwn0erarMsheef,ury;9atn,andLPcoCeJ