HomeMy WebLinkAboutAge_Hyatt APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
"': State Form 43708(R9/9-08)
Prescribed by the Department of Local Government Finance I, ')
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: APR 2.6 2013
To be Med in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is a efiec
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prop e (12)months
before March 31 of the year the deduction is to be effective. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check an that apply)
td Over 65 Deduction from Assessed Valuation t213ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is appka a solo legal or equitable a eft If No,what is his/her exact share or interest? If owned whh someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than that of applicant.indicate below
Name of contrac Tc ter(appfirant must have been buying on contract at least one(1)year)
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Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
I XI Real property ❑ Mobile home(IC 6-1-1-7)
ing d tract Key number I Legal description Record number Page number
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Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182.430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If fled by a surviving,unnamed spouse,
prior to the current yeaR what was the spouse's age at the time
❑ Yes ❑ No of death?
Adjusted gross income of applicant,spouse,and any
111 Yes ❑ No
I/We 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 applicant Address of applicant (number and street,city,state,and ZIP code)
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Signatu•of authorized represents' dress of authorized representative (number and street,city,state,and ZIP code)