Age_Whitehead1 '
ej °"na APPLICATION FOR SENIOR CITIZEN cOUNiv TOWNSHIP YEAR
i��f PROPERTY TAX BENEFITS I
State Form 43708 (R70 / 72-08)
•����� Prescribed by the Depanmem of Local Govemment Finance � �
Information wntained in ihis document is CONFIDENTIAL pursuani to IC 6-1.1-72-9 and IC 6-7.1-35-9.
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INSTRUCTIONS:
To be filed in person or by mail with lhe CounryAuditor ot the county where the property is /ocated. DEC 2'9 20�5
Filing Dates: 1J Real Property: Dunng the twelve (72J months be/ore December 37 0/ the year the deduction i to be e'lfnec't'iv'e,.�
2) Mo6ile Homes assessed under IC 6-7. iJ or manufactured homes not assessed as ieal prd��pg�qp.vE1
X+wltiP
be�ore Maroh 37 o�the yearthe deduction is to 6e eRective. GISSON COUNIY AUDI
See reverse side for additional insfrucfions and quali/ications.
Type of bene(t requested (p/ease check all fhaf apply)
� 65 Deduction from Assessed Valuation �Over 65 Circuii Breaker Credit
' Name of a pliwnt (owner w contr cf buyer)
��u��� � � � �Q �
I I: nt Ne sde legal or ble ov+nef? If No, what is hislner ezact share or interest? If owned wiN someone other
in0icate with whom
❑ Yes ❑ No
If name on record is diHerent than that of applicant, indicate below
Name of conuact seller (applicant musf have been buying on contracf af leasf one (7) year)
Address of contract seller (number and s(reel, city, state, and ZIP code) Is the pmperty in question:
❑ Real property ❑
7awng distnct Key number / Legal desaiption Recortl number
2�- �g-o�- �a� - a�. �s9- a�?
Is ihe pmperty use0 and occupied primanly for Assessed value of the property as of March 7, anent yi
�is/her residence? , �or Over 65 deduction, o� 5760,000 Ior fhe Over 65 Circi
Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
prior ro ihe year taxes are first due and payable?
❑ Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (Fo� Over 65 deduction, income
may not exceed 525,000; for the Over 65 Circuit B�eaker Credit,
income may not exceed S30,000 (or individuals, or S40,000 lor
married couples).
Have you filed for any o;her deductions?
Have you (led for deductions in any
Yes
❑ Yes
was a resident