HomeMy WebLinkAboutAge_BryantAPPUCATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
` ... .' Sbta Fortn 43708 (R9/9-OB)
� PrasaibeE by Me Departmem oi Lxal Govemmem Finance
IrAortnetiom m�tainetl in Nis tlocument is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC F7J3S9.
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INSTRUCTIONS: s(�/ ','(�!Vj�,�
TobefileeinpersonorbymeilwifhUreCountyAUOitwolthemuntywAeretheproperryislocated. QI�B�NCOUN�AUa1TOR
Filing Dates: 7) Real Property: Dunng the fweNe (12) marths befare December 3/ 0/ fhe year the deducUon is to be s ectrve.
21 Mo6ile Hames assessed untler IC G7.1-7 or manulactured homes irot essessed es real propeAy: Dunng fhe hveNe (72). months
6e%re Maich 3f ol the year the r/etluction is to be eflective.
See reverse slde la addifionellnsWCtions aiM qualificetlons.
Type d 6enef.t �uested (please Meck aC fhal apply)
� Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name af epd'�ranl (owrier of Cu'iG(a�tt OvyBQ
V "� " —
la ev01' rit ihe saa lepal or epuitaMe owneR tt No, what u hisRier exact share w interesl? tt owned with someone dher Ihan spouse.
indimta wiih wMm
❑ Yes ❑ No
M name on record Ls diftarent Ihan lhat of appliont, IMi�ate bebw
Name ot contrad sallar (app4cant musf hava Oaen Ouyinp on contrad at least orre (f) yearj
Pdd`ess of contratl seller (mmber aM abee(, ciy, sfate, aM ZIP mtle) is tha o�ooeM in ouestion:
� Real pmperry � MoDile home (IC 644-7)
� 7�ppaistricl Keynumher/Lepaldescnption �Recordnumber Pagenumoer I
��� alp-/a-rl-3an -aoo. so9-do�
la Uie yopeM � end ottupetl primaNy br luseued value ot the pmDarty as o( Ma¢h 1, curtent yaar (may nof e+ceed SiB2,a30
tdarhar rasiden�? !or O�er 65 dotluGion. a 5160.000 !or tho Ovcr 65 Circw Broakor Cretliq
�Yes ❑ No
YVaa 1�e apWi�aM 65 years of a8e or more on Decembar 31 01 the year
otdeath?
�
Adjusted gross income of appliwnt, spouse, and any Source ot inwme amount ot income �
individuals sharing ownership (For Over 65 deduction, income � Q j OD
may nof exceed 525, 000; tor fhe Over 65 Circuif Breaker Credit, a 00 `� ,S 5 py $
incane may raf exceed S30,000 /or individuals, or 540,000 for I 5 I
married couples).
ITOTAL 5( 9� 30 O 0.00 I
Mave you (Jed tw aery other ded�ctiona7 If Yas, whal dedudions?
�,�5 ❑ No H.s. /n-t
Have you Poed tor deductions in any other couMy9 u Yes. wtiat wunry'! `
❑ Yes ❑ No
IIVJe cartify under penalty of peryury that the above and foregoing information is tr�e and cortect and thai the applicant was a residenl
of Indiana and owner of the aforementioned property on March 7, 20
sp� r� d eod'�m <daress o� sovumm (mmDa a�0 sboe4 �Y• state. aM �a �oda�
�' ti �D�s rr�s o� .� ��D
nature d euthw¢eO re� e Addass of eWhwaed rapraseniaWe (num6er aM s✓cet tiry. sta:e, and LP cotla)