HomeMy WebLinkAboutAge_Dickinson s.- ' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR"'Y PROPERTY TAX BENEFITSC7-
State Form 43708(fM I 9-08)
Prawihed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1A-12-9 and IC 6-1.1-35-9 ,. .t 'V
INSTRUCTIONS: 1 A
To be filed in person or by mail with the County Auditor of the county where the property is located. APR 1 0 2014
Filing Dates: 1) Real Property:During the twelve(12)months before December31 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 ppperty:D n (12)months
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 benefit requested(please check as that apply)
I lA Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of apprcant(owner or contract buyer) ^) ��' ///111��' /�'
Is applicant the sole legal or equitable f No,what exact 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 contra seller(applicant must have been buying on contract at least one(I)year)
Address of seller(number and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
�nTaxing district Key number/Legal description Record number Page number
OA C4O.fi (9-(P- 11— la_a o l-boo. 13o-oaa
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? rrte({ for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
0.Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Ws,what deductions?
El Yes 0 N
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes 111 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).. 4
Signature of prized representative Address of authorized representative (number andstreet,city,state,and ZIP code)