HomeMy WebLinkAboutAge_Frey a..-,. APPLICATION FOR SENIOR CITIZEN Ica }.Ri'>;�,4 !,;YEAR
PROPERTY TAX BENEFITS /
State roan 43708(R9/9-08)
Prescribed by the Department of Local Government Finance
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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: nr n ��
To be filed in person or by mail with the CountyAuditor of the county where the property is located. GIBSOJ/N+I`ACOUNTY�^ � ^�^A'�`UDITOR
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:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benett requested(please check all that apply)
65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
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Name of applicant(own a cantrad buyer)
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Is applicant the sole legal equitable owner? If No,what is his/her exact share or interest? dined with someone other than spouse,
i ndicate with whom
Yes ❑ No
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If name on record is different n that of applicant indicate below
Name of contract seller(applicant must have been buying on contract of least one(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property rty in question:
eat property ❑ Mobile home(IC 6-i-1-7)
Taxing district Key number/Legal description ecord number Page number
V T Le) ? aA.•b4-35.3ao- obo foce I�
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 3182,430
his/her residence? for Over 65 deduction,or S160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No I
Was the applicant 65 years of age or more on December 31 of the year Applicant's dale of birth(month,day,year) If fled by a surviving,unmarried spouse.
prior to the current year? what was the spouse's age at the time
❑ Yes 111 No
of death?
Adjusted gross income of applicant,spouse,and any
1� 95 El N0
Have you filed for deductions in any other county? l If Yes,what county?
❑ Yes P,Po
I/We certify under penally 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)
Si natu of authorized representative dress of authorized representative (number and stro4t,city,state,and ZIP code)