HomeMy WebLinkAboutAge_Brakebill f; " APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
-4it'l PROPERTY TAX BENEFITS
State Form 43709(R13/4-15)
c' Prescribed by the Department of Local Government Finance 1` . Wl w t�`(� 9O 11
File Mark _`
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 located. -
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 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
• Type of benefit requested ease check all that apply)
Over 65 Deduction from Assessed Valuation LN Over 65 Circuit Breaker Credit
Name of applicant(o er contract buyer) JJ�\
S � , 11
Is applicant the sole legal or tie 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 that of applicant,indicate below F IL E.ri tenants or tenants in common reside on the property?
( l ❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
MAY 1 3 ZBt9ract for at least one(1)year before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street city,state,and LP code) I in question:
GIBSON COUNTY AUD Real property ❑ Mobile home(IC 61-1-7)
Taxiing district Key number/Legal description R number Page number
GasktAi 26-- I -23 —IMO-000 . 163-0 .
Does eppll ant reside on property? AssKwd value of the property aso of current year assessment date(maynot exceed
$192,430 for Over 65 Deduction or$159,999 fcountugJust the homestead site)torthe Over
❑ Yes ❑ No 65 Circuit Breaker Credit)
Yes ❑ No l
•
Have you filed far deductions in any other coun �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 apnt Address of applicant (number and street,city,state,and ZIP code)
41.1<,G1/ C t O t) t►�1p n Si lot S .+�� h
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nature of authorized rear ee tative Address of authorized representative (number and stria&city,state.enlZ/P code) ClL^l r 1 -
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