HomeMy WebLinkAboutAge_DeputyAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
� S ' Sq1e Form 43708 (R9 / 9-OB)
Prexnbed hy Ma DeparLmem of Local Govemmem Finance
I�ortnaliom m�ffiined in this dowment is CONFIDENTIAL pursuant W IC 6-1.1-12-9 and IC G7.135-9.
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COUNTY TOWNSHIP � YEAR
APR 2 2��`k
INSTRUCTIONS: � � �
To be fi/ed in person or by mail with the CountyAudita ol fhe oounty whera tlie property is located.
Filing Dates: 7) Real Properfy.� Dunrg Ne AveNe (f 2) mmths before December 31 o71he year the dedur�����r qUDITOR
2) Mobde Homes essessed urrder IC Cr7.1-7 or manufectured homes rrof assessed as �eal property: Durimrg the MeNe (72) months
6e/ore Mart,ii 37 0/ the yaer the detluction is fo 6e eflactive.
See ieverse side Iw atltlitional insbvdions eM qualiAcations.
Type af 6enefit fepuested (pl d+eck e0 Nat ayp�
Over 65 Deduction hom Assessed Valuation Over 65 Circuit Breaker Credit
Name of epqicaM (owrrer n cmtracf ouyeQ
V
Is appli�M Ne sde lep apuita owneR It No, is his/her exad ahara w inte�esll R owned with someana olher Ihan spouse,
' intliWtewithwhom
es ❑ No
tt name on recad U d'fierem Ihan U+al of eppGCan� inOZate bebw
Nxme d comraa senar /epd��a�� m� nave eeon nuyrnp an cam,raa ar least olre f�J ra80
P.tldrass of contretl selier (numbarand sbeaf, cily, sfefo, antl ZIP wde) �s iha p�ooe�ty in Question:
� Real property � MoDile home (IC 644-�
Tmcinp distrid Key number / legal description RecorE number Page number
ab-13- - -o .a3 -o�
e pmperty use0 atk ottuped onmariy br Assessed value of ihe D�oOeM as ot March 7, cuRent year (may rrof erceed 5f82,d?0
his/ner resiEence7 Por O�er 65 deduGim, a 5160.000lor Ne Ove� 65 Cirpit &eekar Credin
❑ Yes ❑ No
Waz lhe eOD�KeM 65 yean of ege w mora on December 31 ot lha year
Have you fded for am/ other deducUms7 �� `bs, what deductlons7
� Yes ❑ No
Have you fJetl for deductions in any dher cw'rty7 It �9s, what counTy?
❑ Yes ❑ No
IIWe certify under penalty ot perjury that the above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20
Signature af appGCeM Pddress qf eppl� �f( (ntv�r� stre�4 � state, aM ZIP w0o)
� � � `� n Gd
g ature ol ulhoriz p ative resa oi eWhmizad reWesania ive (num sLOOt, ciry. stafo, antl LP code)