HomeMy WebLinkAboutAge_Comer { APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
1, PROPERTY TAX BENEFITS
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\ ,�. State Form 43708(R13/4-15)
—d Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is lopysl.1'h 011
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmadFcdEFF[d1'FFbbii y e fo owing January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real pro erty:During t e tw (12)months
before March 31 of the year the deduction is to be effective. JNnI`b,'
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benefit requested(please check all that apply) �,//
Over 65 Deduction from Assessed Valuation IX 65 Circuit Breaker Credit
Name pplicant(owner or contract buyer) Ca al o �'{D //{,,. n t
Is applicant the sole legal or equi a owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the properly?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property ub f P png under recorded
contract for at least one(1)year before daiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street,city,state,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
C9 -rase&-3m-o0133a '
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$182,430 for Over 65 Deduction or 5159,999/counting just the homestead site)for the Over
65 Circuit Breaker Credit.)
❑ Yes ❑ No
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you tiled for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you riled 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.
Signature of-• licant I Address of applicant (number and street,city,state,and ZIP code) Pre�G ��
7 .., 24‘ el
ignature o authorized representat,'- •ddress of authori -•representative number and street,city,state,and ZIP code)