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el. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR I
PROPERTY TAX BENEFITS F 1.. I.j E
State Form 43708(RIO!12-08)
sail 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. MAR 91e/13115
INSTRUCTIONS: filiem4rer
To be filed in person or by mail with the County Auditor of the county where the property is located.
GIBSON_COUNTY AUDITOR
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/C 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Ng Over 65 Deduction from Assessed Valuation X0ver 65 Circuit Breaker Credit
Name o licant(owner or contract buyer)
I/
/
Is applicant the sole legal or equitable owner? If No,what is higher exact share or interest? If owned with someone other than spouse,
indicate with whom
XYes 111 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(I)year)
Address of contract seller(number and street,city,state.and ZIP code) Is the property in question:
X I
Li Real property Mobile home(/C 6-1-1-7)
Taxing • trict 1 Key number/Legal d cription Record number Page number
•
Az/zegici4C) c27‘-/0?-0 2- .5.00..ed/V-oalP
Is the property used and occupied primarily or 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)
[11 Yes I I No
i Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day year) If tiled by a surviving,unmarried spouse,
prior to the year taxes are first due and payable? what was the spouse's age at the time
of death?
ill Yes n No
Adjusted gross income of applicant, spouse, and any Source of Income I Amount of Income
individuals sharing ownership (For Over 65 deduction, income $
may not exceed$25,000;for the Over 65 Circuit Breaker Credit,
income may not exceed$30,000 for individuals, or$40,000 for I $
married couples).
TOTAL I $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
0 Yes CI No
Have you filed for deductions in any other county? If Yes,what county?
Lives I ' No
INVe 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 .
ic Signature of applicant Address of applicant (number and street.city,state,and ZIP code)
l• - ?(
.70 ci 3 , Spvit c_, e_ 5 A ,--Pc-; Pi e,e16 n t (0 Li 761O
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code) i
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