Age_Reed (2) .'x:--o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP i YEAR_ _
- .."-*".1 PROPERTY TAX BENEFITS
['F ' State Form 43708(R919-08)
S ice I Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. F //CeEkD
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. I II II 1� �R( 2014
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be�Rat1iv9:
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real properly:During the twelve(12 mon
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)
12 Over 65 Deduction from Assessed Valuation 1St-Over 65 Circuit Breaker Credit
Name(In applicant(o��wnn�err�oroc'onttra/d buyer) /'//
"L �' /
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(1)year)
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
pReal property ❑ Mobile home(IC 6-1-1-7)
Taxing 'thct Key number/Legal description Record number Page number
Li -27 z loiR-aS'-ao3 -ooa-95/ca Sr
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 Over 65 deduction,or S160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you fled for any other deductions? if Yes,what deductions?
® Yes lc No /7/ s
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes 171 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)
Signature of authorized representative Address of authorized representative (numb rand street,city,state,and ZIP code)