HomeMy WebLinkAboutAge_Settle et, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
:a--. PROPERTY TAX BENEFITS
..,. State Form 43708(R13/4-15)
%er; 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. `
APR 12 2018
INSTRUCTIONS:To be filed 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 fol vtng Jar a
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Du months
before March 31 of the year the deduction is to be effective. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
pOver 65 Deduction from Assessed Valuation [Aver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) 0/)q S�J22Tey`
Is applicant N�otab er 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 property?
lnYes ❑ No
Name of contract seller Hasa licant owned or been buying the property PP year g l png 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 properly in question:
, Real property ❑ Mobile home(IC 6-1-1-7)
Taxing di
yalc
t Key number/Legal description Record number Page number
z 6-11-1,1-jar -Cr/ 75(0 -00R 7
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
5162,430 for Over 65 Deduction or 5159,999 fcounting just the homestead site)for the Over
❑ Yes ID No 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day year) If filed by a surviving,unmarried spouse,what
prior to the year taxes are first due and payable? was the spouse's age at the time of death?
❑ Yes ❑ No
Adjusted gross income of applicant, applicant and spouse,
❑ 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 code)
"/Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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