HomeMy WebLinkAboutAge_Brown (2) t'%:- • APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
.`"' PROPERTY TAX BENEFITS ---
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State Farm 43708(R9/9-08)
Prosrn'hed by the Department of Loral Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-11-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. APR 3 0 2013
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Dufl Ure twe (1 on
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benedt requested(please as that apply)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the sole legal or equitable • r? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
Yes ❑ NO
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract suer(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
A- 1/7-1b- w-b 3 96a-Cia
Is the property used and occupied primarily for
❑ 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)• •
Signatffum of uthorized representative Ad ress f authorized representative (number and street,city,state,and ZIP code)