HomeMy WebLinkAboutAge_Kearns"' APPLICATION FOR SENIOR CITIZEN courm TOWNSMIP r�aa
rs -. - . PROPERTY TAX BENEFITS �
Sqie Fortn 43708 (R9l 408)
•� � Prescnbed by the Dapartmerit of Local GovemmeM Finance
��.� 12�I�a�
Informatiom m�iained in this doamen[ is CONFIDENTIAL pursuant to IC 6-1.142-9 and IC 61.1-35-9. ^ p p 1',
r1r r� i
rNSrRUCnoas:
To be filed in persm or by mail xith the CountyAUtli(or o! the county where fhe property is locatetl. C'� �
Filiry Dates: 7) Real PropeRy: Dunng the tweNe (12) months 6e/ore December 37 0l the ysar the deduction is to 6e �efl�e�ctWirsT.Y AUD�T�R
2J Mobile Hwnes assessed under IC 6-7.7-7 ormanu/acfured hwnes rrot assessed es real �61uw�melwslve (12) months
6e/rne Mardi 3 f o/ (he year the deduction is to be eRecfive.
�,
u
i/
y
See reverse side (or additional inshudions and quali(ications.
TyPa ��neft repuested (pl dieck aH Nat aPply)
Over 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit
Name of applicam (awner w corrtracf Ou}er)
Is app6mM ihe sde legal or apuitade Y! If No, what is h¢iher exad shara w'urtarast7 tt amed vrith mmeone othar than spwse.
indimte with whom
es ❑ No
H nama on racord is diRerent than Nat at apd�ni �ndicale babw
Name of mitrad seller (appficanl must hzve been 6yvy m canfraG at kast arre (1J yraQ
AEdrass of mntrad sellet (num6er aM sbea4 �+h', slate, aM ZIP mEe) Is lhe property in Queslion:
� Real pmperty � Mobile hwne QC &7J-n
a�}�y Keynumber/Lepaldescnplion Recordnumbar Paganumbar
- yl �
Is the v�M �� aiW occupied primariy lor Assessed valua oi tha pmverry as ot March 1, wnant year (may rwf arceed 57B2.a30
hisRier residanca7 loi Orer 65 derl�Cim, w 5160,000 Ior Iho Ovor 65 Ci�crut &eaker Cred�Q
es ❑ No
Was the appfirs+tl 65 years ot age a mora on Oecember 31 ot tha year Appli�am's tlale of biM (mmth, da% yea� I( filed by a wrvrvin8, unmartied spouse,
peior lo �ha arren� yeaY.� what was �ha spouse's age at ihe �ima
' � ^� � ^ ore��n?
� Yes ❑ No ��
Adjusted g�oss income of applicant, spouse, and any Source of Inwme Amount oi Income
individuals sharing ownership (ForOver 65 deduction, income $ ��
may not exceed 825, 000; for fhe Over 65 Circuit 8reaker Credif,
income may rrof exceed $30,000 forindividuals, or 540,000 for $
married couples).
TOTAL 5 O.OD
Have you (Jad tar a(ry oiher dedWions7 If Yes, what tleductions?
� Yes ❑ No
Have yw fdad fn dedudions in any dher counryl I( Ms, what cwiriy7
❑ Yes ❑ No
IIWe cer5fy under penalty of perjury that the above and foregoing information is true and cortect and that the applicant was a residenl
of Indiana and owner of the aforemenlioned property on March i, 20
Signaturadappfcant AEdressofapplimnt (numberaMStroo4u�Y.��.aMZlPcotla)
�15y S D v
Signalure of authorized represemative Pddress ot aulhrnize0 represenfative (numDerand sheet aN. state, and ZIP co0e)