HomeMy WebLinkAboutAge_Beasley E' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
°b PROPERTY TAX BENEFITS
6t tl State Form 43708(R10/12-08)
�u,: 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. ' i
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. ����((11��// 1""
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction AO be hrf&tit @16
2) Mobile Homes assessed under IC 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. GIBSON COUNTY A
UDITQR
Type of benefit requested(please check all that apply)
NI Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner
�orrr contract buyer) °�/J�'��'�'��
Is applicant the sole legal or equital owner. If No.wh I his/her exact share or interest? If owned with someone other than spouse,
vindicate with whom
Yes ❑ No
If name on record is differen than that of applicant,indicate below
Name of contract seller tap ticant must have been buying on contract at least one(1)year)
� Is the property in question:
Address of contract seller(number and street,city,state,and ZIP code) 9
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
ICI1/4-Jf-A2 ; (9_ 1-5-dfl —/03—OM 0/fOQS
Is the properly used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
histher 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
Adjusted gross income of applicant, spouse,and any
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes Eg No
Have you filed for deductions in any other county? If Yes,what county?
n Yes yNo
IMe 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 code)
�rLr,�j' _ ( °3oas.ea ty St J ,'1 L/7�N9
Sig of Wort d representative Er'� Address of authorized representative (number and street,city,state,and ZIP code$
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