HomeMy WebLinkAboutAge_Logsdon (2) %;,A. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
.-j•f":4 PROPERTY TAX BENEFITS
,..):; State Form 43708(R9/9-08)
S i.,.� Prescribed by the Department of Local Government Finance 1 Mtn
`'e Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-3S. -
INSTRUCTIONS: APR 2 1 2014
To be filed in person or by mail with the CountyAuditor 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 ded Lion is to be eff tive.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as SI ' the twelve(12)months
before March31 of the year the deduction is to be effective. GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requestteeddd(please check at that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of app/ (owner or contract bulGr)
Is applicant 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
4Yes ❑ No
If name on record is different hthan that of applicant,indicate below
Name of contract s Ierr(a`p'plicant must have been buying on contract at least one(1)year)
Address of contra seller(number and street,city,state,and ZIP cede) Is the property in question:
ep
ILL I Real property ❑ Mobile home(IC 6-1-1-7)
Taxin - trict Tax number/Legal description Record number Page number
aka I 1-oa-300-09l-a7a 0a7
Is the property used and C-_ pn, n, r Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Brealer Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
❑ ��----yy��Yes �Np
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,stale,and ZIP code)
ignature of authorized representative Address of authorized representative (number and street,city state,and ZIP code)