Loading...
Age_Clark x... APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR ' PROPERTY TAX BENEFITS State Form 43708(R9/4O8) Prescribed by the Department of Loral Government Finance _ ,-. File Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1. �i3.-9. .. INSTRUCTIONS: 1 To be filed in person or by mail with the CountyAuditor of the county where the property is located. MAY u 1 2014 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 a al pro • e 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 all that apply) er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of applicant yer)V' \ S li Is applicant the sole legal or equi j 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 seller(applicant must have been buying on contract at least one(Dyed) Address of contract seller(number and street city,state,and ZIP code) Is the property in question: ❑ Real property ❑ Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number a�iws -4oa-po'3ob-ate Is the property used and occupied primarily r Assessed value of the property as of March 1,current year(may not exceed Sf8Z430 his/her residence? for Over 65 dedudim,or$160,000 for the Over 65 Circuit Breaker Credit) ❑ Yes ❑ No Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If filed by a surviving,unmanied spouse, prior to the arrant year what was the spouse's age at the time ❑ Yes ❑ No of death? Adjusted gross income of applicant, spouse,and any Have you filed for any other deductions? If Yes,what deductions? ❑ Yes ❑ No Have you filed for deductions in any other county? If Yes,what county? 111 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 appf Address of applicant (number and street city,slate,and ZIP code) l 3 l F i�o .c - ©c -, ature of suet rep esentalive Address of authorized representative (number and street,city state,and ZIP code)