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HomeMy WebLinkAboutAge_Dossett ei "o' APPLICATION FOR SENIOR CITIZEN _ COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS % r State Form 43708(R13/4-15) • 61 Prescribed by the Department of Local Government Finance File Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. FILEDINSTRUCTIONS:To be(led in person or by mail with the County Auditor of the county where the property is located. Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the ro pvrig�,)la� 2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Durir 'tlfA tiel4e It months before March 31 of the year the deduction is to be effective. See reverse side for additional instruction and qualifications. Type of benefit requested(please all that apply) GIBSON COUNTY AUDITOR ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) WpV / al Is applicant the sole legal or equitable 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 Hasa applicant owned or been buying vying ree property under recorded contract for at least one(1)year before claiming deduction? ❑ Yes ❑ No Address of contract seller(number and street,city.state,and ZIP code) Is the property in que on: eal property ❑ Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number alo -DE-Sge ©a6- pot.orvitt g Does applicant reside on property? Assessed value of the property as of current year accAcsment date(may not exceed $182,430 for Over 65 Deduction or$159,999(counting just the homestead site]for the Over ❑ NO 65 Circuit Breaker Credit.) ❑ Yes See reverse for details. Is the applicant 65 years of age or more on December 31 of the year Have you filed for any other deductions? If Yes,what deductions? ❑ Yes ❑ No Have you filed for deductions in any other county? If Yes,what county? U Yes ID No I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant Address of applicant (number and street,city,state,and ZIP code) ,e; PO. a C. sa. P4frL S�„4 ?r�‘ Sig of authorized mere ntative Address of authorized representative (number and street,city state,and ZIP code)