HomeMy WebLinkAboutAge_Smith (6) APPLICATION FOR COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
CITIZEN
State Form 43708(R9/9-08)
.i. f Prescribed by the Department of Local Government Finance
File Mark
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Infortion contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. l '
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. ,11t
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deductioq RR.89 9'h
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.
GIBSON COUNTY AUDITOR
Type of benefit requested(please check all that apply) (�
1 111 Over 65 Deduction from Assessed Valuation (x Over 65 Circuit Breaker Credit
Name of appferam( TC� `^off ' fin' /\
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
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract ssel/lerr(ap1lyCleant must have been buying on contract at least one(1)year)
Address of contract salter(number and street,city,state,and ZIP code) Is the property in question:
I q Real property ❑ Mobile home(IC 6-1-1-7)
Taxing distric,.... ...70 Key number/Legal description Record number Page number
jt,Uj�f,1� 1�j1~ Sv 41-1�/o r°a.cI6tt-oa"8
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? for Oyer 65 deduction,or S160.000 forme Over 65 Circuit Breaker Credit)
jaYes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes IL■o
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes No
INVe 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 properly on March 1,20. .
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
f' 6i -/ / . f° //OF( 7AUL
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)