HomeMy WebLinkAboutAge_Gamblin "4%, : APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Forth 43708 spa 9-08)
Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IYI' .113892013
INSTRUCTIONS: A
To be filed in person or by mail with the CountyAuditor of the county where the property':Y ai
i,jy:'i/�h
Filing Dates: 1) Real Property:During the twelve(12)months before DecemMiti 31 i i VIM r.- ,• ovreme effective.
2) Mobile Homes assessed under IC 6-7.7-7 or manufactured?omes not assessed as real property:During the twelve(12)months
before Mardi 31 of the year the deduction is to be effective.
See reverse sale for additional instructions and qualifications
Type of benefit requested(please check as that apply)
Over 65 Deduction from Assessed Valuation /� El/Elver 65 Circuit Breaker Credit
Name of app(L/p�M/�ff//�r�racmtracl6uye0 1 (
Is appfimm the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
/jes ❑ No
If name on record is different than that of applicant indicate below
Name of contract sells (applicant must have been buying an contract at least one(1)year)
rTh
Address of contraadr I(number and street city,state,and ZIP code) Is the property in question:
4 Real property ❑ Mobile home(IC 6-1-1-7)
Taxi district Key number I Legal description Record number Page number
l t �� C c9 6 / /8-Y-0/-(mil. (9301_007
Is the property used and occupied primarily
❑ Yes ND
IfWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1,20 .
Signature of ap--scant Address of applicant (numb and street,city,state,and ZIP code)
Signs ure.authorized rep---ntative Address of authorized repre native (number and street,city,state,end ZIP code)