Age_Meeks (2) ems'°a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
PROPERTY TAX BENEFITS
CE
'' State Form 43706(R70/12-08)
O Prescribed by the Department of Local Government Finance y
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. F 1 11 en
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. iii 2015
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be e1fFec'fiv-
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Dud the twelve(12)months
before March 31 of the year the deduction is to be effective.
/
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benefit requested(please check all that apply)
1%1 Over 65 Deduction from Assessed Valuation LJ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) !`
Is applicant th sol legal or equitable owner? It No,what is his/her exact share or 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 cont act 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:
VReal property ❑ Mobile home(IC 6-1-1-7)
Toxin district Key number/Legal description Record number Page number
Il !/ticCek� 3\64i-1a-toy-ay. -7`�
Is the property used and occupied primarily 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 Applicant's date of birth(month,day year) If filed by a surviving,unmarried spouse,
prior to the year taxes are first due and payable? what was the spouse's age at the time
CI Yes U No of death?
Adjusted gross income of applicant, spouse, and any
Have you filed for any other deductions? �Y1 t If Yes,what deductions?
ta
❑ Yes , No
Have you filed for deductions in any other county? / If Yes,what county?
❑ Yes to
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 co/deeJ��1 - / / 7/ ��
// / /d '/�//[L(1(�L/ ��/`r/'.l. r0
Sur f authorized representative Address of authorized representative (number and street.city,state,and ZIP code)
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