Age_Hicks APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
st, -•. \ PROPERTY TAX BENEFITS
'/ Sate Form 43706(R12/6-14)
rni/ Prescribed by Mee Department of Ural Government Ginarre p-1
J EYIe.Merktsf
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: NOV 3 2014
b be Red in person or by mad with the County Auditor of the county where the property is located.
Fag Dates: 1) Real Properly:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-2 or manufactured homes not assessed as real property:Durring the twelve ; . s
before March 31 of the year the deduction is to be effective. $.14
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benefit requested(Please clad,'as Tat aPP') III���TTT
® Over 55 Deduction from Assessed Valuation p) Over 65 Circuit Breaker Credit
Name of apple m(owner a contract dyer) I `
C(, nS-1znnca T. nicks .
Is apprcam be sole legal or equable owner? If No.what is fibber exact share or serest] If owned ram pmt tenant or tenant it common.
ineiate wen whom
Yes ❑ No
tarmac on reedit is Mierent Man that of apolcant indicate bebw Do as joist tenants or tenants in common reside on die property?
❑ Yes ❑ No
Name of contract seller Hes applant ow'nee or been ben g MM ceoper N'under recorded
c ntract lo.at least one(1)year before daLmesg deduction?
Yes ❑ No
Address of contract seller(number and street oty gate.and ZIP code) Is be property in question:
4 Real properly ❑ Mobile home(IC 6-1-1-2)
Taxing debts Key number I Legal desmpim I Record number Page number
`PAtntar ■ 0110&-07-1oa-ooh. /94-add?
. Does sppsant Teske an pope:y? Aaaessec vza,e of are proper'y as a earth I,cones year(may not eraed$182.430
ex Over 65 aedvion.er 5:60.000)w Lee Oren b5 Cvart&raker LreCtl
err ❑ No carted 51e2,430)
Yes
Is Pe apiVUN 65 years or age or rifle on December 31 of the year
Hare you tiled toe any other dear born? n Yes.what deductions?
�/ r ,/ '_"�
® Yes ❑ No 11 1ebleS 4 ._ ✓ /Y //have-108i
have you filed la deauorons it any other county? iI-- It Yes,what county? I
V❑ Yes S No
Wile certify under penalty of perjury that the above and foregoing information is true and correct.
Sagniye of applicant adders Of appecart Invader and street ay stale.and ZIP code)
50s N /PS� II irAkP Le)
sgaare aasriion..edro sMati+e Address a autinced reaeseratue(number add sheet otr state.and ZIP Le)