HomeMy WebLinkAboutAge_Richardson (2) 'n' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
ek--. - % PROPERTY TAX BENEFITS
State Form 43708(R9/9-08)
•� n.. i 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 6-1.1-35-9.
INSTRUCTIONS: FILED
To be filed in person or by mail with the County Auditor 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 deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:D$ qth8 twelfj7 )months
before March 31 of the year the deduction is to be effective. JJ��
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
1 GIBSON COUNTY AUDITOR
Over 65 Deduction from Assessed Valuation "Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
d ►'Ylokj d a a
Is applicant the sole or ape",owner? If No.what is his/her exact share or interest? If owned with someone other than spouse,
_ indicate with whom
® Yes Ill No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been bays g on contract at least one(1)year)
Address of trad seller(number and street,city,state,and ZIP code) Is the property in question:
MReal property ❑ Mobile home(IC 6-1-1-7)
Tateing�ist� Key number/Legal description Record number Page number
"1/r/,J, &( la-o Ra7Ct3-do/..2 177-03 3
is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residence? for Over65 deduction,or 5160.000 forthe Over 65 Circuit Breaker Credit)
ISYes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
❑ Yes ® No
liWe 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)
C x ti ' >0 S0 1 d-cur PA 04 4 ✓f''
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)