Age_Coomer e ii APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R9/908)
Proscribed by the Department of Local Government Finance _
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. - �,
INSTRUCTIONS: SEP 2 3 2014
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Properly:During the twelve(12)months before December 31 of the year the deduction is to a effective.
2) Mobile Homes assessed under lC 6-1.1-7 or manufactured homes not assessed as real props 13)trjng ve"(7Zrmonfhs
before March31 of the year the deduction is to be effective. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested((please check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) �r /�
&//!/C? 74 C. oo� er / /bt%Is applicant the sole leg or equitable owner? If No,what is his/h are or interest? If owned with someone other than spouse.
indicate with whom
Yes ❑ No
If name on record is di rent than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(I)year)
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
heal property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Vialietfil� o?L�9/8' S'o/ao / 5ta d�
Is the property used and occupied .y 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$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
_
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes n No
Have you filed for deductions in any other county? If Yes,what county?
111 Yes ❑ 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)
Ale
Signature of authorized representative Address of authorized representative (number and street,city,date,and ZIP code)