Age_Loomis!`
APPLICATION FOR SENIOR CITIZEN
- . PROPERTY TAX BENEFITS
Sfate Fwm 43708 (R9 / 9-08)
'O � PrasrnbeC by ihe Department o( Local Govammant Financa
Informalion containetl in this doament is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 61.1-35-9.
INSTRUCTIONS:
To be filetl in persm or by mail with fhe CountyAUtlita o1 the munty whera fhe propeAy is locatetl. N(� V 1 3 Z� � 2
Filing Dafes: 1) Reel Property: Dunrg the hvelve (72) marths be(rna Decsmber 31 o/fhe ysarthe tleducfion is to 6e efiectivs.
2J Mobife Homes assessed urMer IC 61.1-7 or manufacfuretl hanes rwf assessed as real p�operty: LLaNRj p��months
6efae Ma�rh 37 0! fhe year Ihe deUuction is to 6e eNective.
SeereversesidefwedditionalinsWClionsarMqualificatians. GIBSON COLINTY AUDITOR
Type d benaH reque9ed (please Metic a0 fhat app�y)
�Over 65 Deduction 6om Assessed Valuation Over 65 Ciiwit Breaker Credit
Name of app4pM (ownar or caNact 6uyeQ
� ���Y�t�C.aJ x
U a lipnt tha sde legal or aquitable amafl If No, what is hisThar ezad share w interestl It owned vnlh mmeme othar Ihan spouse.
iMivta with whom
❑ Yes ❑ No
H name m racwd is diReeent Ihan Ihat of app6rant indicate bebw
Name ot mntrad seller (app(¢anf must have Deen Oydng m cmtrdct af least ox (1) yp.ar)
Pddress d mntrad SaAer (number aM sbee4 ah, sfafe, aM LP coCe) �s ihe pmper�y in quesiion:
,�Real property � Mobile home (IC 61-7-�
T�ing dislrkt `/��/ ""-' "`-'M1r KeY number / Leqal descn7tion Recok num6er Paga number
��- �.(o-/�-!3_�0�_00/./.70 -o
U Ne qope(ly used aM amped primarily 1or Asseaed valua ot Iha property az of Ma(rh 1, artant yaar (mey rnt exceetl S1B2,a30
hisTher �asiEancs7 IurO�er 65 dedudion, or E760,000 tor Na Ovei 65 Cuail &mlmi CreAiq
�Yes ❑ No
Wav Na app6mM 65 years o( aga or more on December 31 d Ihe ywr
Haveyou (Jad M atry Wher dedu�onsT If 1§s, what deduGions7
�s ❑No ��. S•
Have yw fJaE (or deCUCtiore in anY �� �^�Y7 If Yes, xRw1 cwMy7
❑ Yes ,�No
I/We cerlify under penalty of perjury lhat the above and foregoing infortnation is true and correct and that lhe applicant was a resident
o( Indiana and owner of the aforementioned property on March 1, 20
SignaWra o( apareM Address of applirem (num0er and stroe4 �: ��, arid ZIP code)
x P� �{ � ��
natu dauthonz ra tive AddressofaNhw'rmdrepresen e n�unberaMSGeef,city,stata,an LPcoOO)