HomeMy WebLinkAboutAge_Clardy °o. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
:b— PROPERTY TAX BENEFITS -
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State Form 43706(R13/4-15)e.�,eu—�. Prescribed by the Department of Loral Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. i
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INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is locgrew 1 201
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real p rty:•Dt velve(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(M se check all that apply)
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) .
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Is applicant the sole legal or equitable owner? If o,what is his/her exact share or interest? If owned with joi 4),enan or tenant in common,
indicate with wh•,.
❑ 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 property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before claiming deduction?
LI 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
96 a 1 O1-aCa— CO 404 - �
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
S182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
El Yes Ill No 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
❑ Yes ❑ No
Have you filed 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 applicant Address of applicant (number and street,city,state,and ZIP cod
yignature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)