HomeMy WebLinkAboutAge_Woomer aAPPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
a1 PROPERTY TAX BENEFITS
6.� r• State Form 43708(RIO/12-08)
\ ' 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. app A @q,�'.
To be�iled!person or by mail with the County Auditor of the county where the property is located. F A L E D
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 propertFE9-irb ldje 5e(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. �T�[
Type of benefit requested(please check all that apply) GIBSON COUNTY AUDITOR
❑'ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ap nt(owner or contract buyer) 110
Is applicant a sole legal or equitable owner? If ,what is his/her exact share interest? If owned with someone other than spouse,
indicate with whom
Li 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 slate,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
at - le-011-103e COO. GQ3 • Oda-
Is the property used and occupied primarily for Assessed value of the property as of March 1.current year(may not exceed S182,430
his/her residence? for Over 65 deduction,or 5160,000 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 ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ 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 plicant Address of applicant (number and street,city,state,and ZIP code)
5--ev ealiaS S.- ate<lii Av L" e j
Signal of authorized reps sentative Address of authorized representative (number and street,city,state,and ZIP code)