HomeMy WebLinkAboutAge_Schupp (2) .rt%a: APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR j
? . PROPERTY TAX BENEFITS
State Form 43708(R9/9-06)
Prescribed by the Department of Local Government Finance .. ..
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1135-9.
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INSTRUCTIONS:
To be filed in �' � Ly t4
person or by mail with the County of the county where the property is located. r..
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be e . .
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as re ro' the twelve(12)months
before March 31 of the year the deduction is to be effective. COUNTY AUDITOR
See reverse side for additional instructions and qualifications. GIBSON
Type of benefit requested(please check all that apply)
14 Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner
/�w/cp�otrY�yar�' buyer) TTT1`����,(`',(_i/ p ct
Is applicant the sole legal or equ' . If No,what is hisib I: -ashore interest? If owned with someone other than spouse,
indicate with whom
N.Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract s1ler(applicant must have been buying on contract at least one(1)year)
lift
Address of contract seller(number and stree(city,stale,and ZIP code) Is the property in question:
Cgt Real property ❑ Mobile home(IC 6-1-1-7)
axing trict /1 Key number/Legal description Record number Page number
�/��°� a�-)a-Il-Ioo -oco.c,39-bO�F
Is the property used and occupied pri ariy for Assessed value of the property as of March 1,current year(may not exceed$182,430
hisrher residence? for Over 65 deduWon,w 5160,000 for the Over 65 Circuit Breaker Credit)
IA Yes ❑ No
Was the applcant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? �/1 If Yes,what deductions?
❑ Yes IlV No
Have you filed for deductions in any other county? IITr���"IIl",,� If`its,what county?
❑ Yes •o
me 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)
>CO �re q7 7'es 3885 5 S"oN I ziwcerow ..ZN 47670
Signature of authorized representative A dress of authorized representative (number and street,city,state,and ZIP code)