HomeMy WebLinkAboutAge_Powers�APPLICATION FOR SENIOR CITIZEN
� PROPERTYTAXBENEFITS
S f State Fortn 43708 (R919-08)
Prewibed by tha Departniem of Local GovemmeM Finance
IMormatiom m�tained in this tloaimen[ is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.'135-9.
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INSTRUCTIONS: � 1
To be filed in persar or 6y mail with the CountyAUd"rfor o/ the county where fhe property is locatetl. DEC, g' y 2 ��Z
Filing Dates: 1) Real PropeAy: Dunng the tweNe (12J marths belo�e Decem6er 31 0/ the year fhe tleduction is to be eflectns.
2) Mobile Homes essessed u�er IC 6-7.7-7 ormanu/actured homes raf assessed as real property: Dunrg the �C'm� Q��i=J " V
6e%re March 31 0/ fhe year the deduction is to be eflective.
See reverse side fwaddi6onal insUVCtions arM qualificatims G�BSON COUNTY AUDITOR
Type d beneEt (equa5ad (ploase Mecic a8 Nal appl7�
UC I Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
(ownor or cmtratt bvyeQ
Is appfpaM itre ade lepql
H nama on record is differ
Name d coniraU 5e0er (¢
Pddress d contratl m0er
r�� a�aa
(..C.� (� J
H No, whal is Ns/her esact share w inlaresl7
❑ Yes ❑ No
f�";W
been b�ryirg m cnntreG af leasf o� (71 Yearf
sbee4
Key number
Is tha
1 �vx� � -��-o �-,� - ovs �93 -a�z➢
arM occvpied primarily br aeE valua o(Ne propE
� lor Orer 65 deducfion, or Ef
❑ Yes ❑ No
Nas the appGant 65 years ot aga v more on Oecember 31 of the year
xior to �he anreM yea(�
❑ Yes � No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not exceed $25, 000; for the Over 65 Circuit Breaker Credit,
income may rrot exceed $30, 000 for individuals, or $40.000 (or
manied couples).
Hava yw filatl (or airy Mher deducCOns7
� Y25
Hava yau fled for deductions in anY other cwrrty?
� YCS
H owned with wmaone other than spoum,
i�Witate vA�h whom
� auastion:
I D�PeKY ❑ Mobile homa (IC &1-0-�
number Page number
Applimnt's data ot buth (manN, day, yoarJ
It Yes. wla� dedu�ons7
� No
If Yes. what cwMy?
� No
iled by a wrviving, unmarried spousa.
rat was the sp�wm'e age al Ure time
a�m7
IIN/e certify under penalty of perjury lhat the abova and foregoing infortnalion is true and correct and thal [he applicant was a resident
of Indiana and owner of the aforementioned properly on March 1, 20
s��a���adavc�m AddressofaPP�nf (numberaritlsbeet,tiy,sFab.aMZ/Pwda)
�, /✓1.�-1 �i'�l�Q%l/1� K)�� �rni.a�.r.:. e� �Iv�CYJ(�,n �i L-(7�'7n
d a ft '[eC reptasentalive I Add`ass of aNhor�E reptasentati� (nwn0efarid slreeL m}: state, end LP mda)