HomeMy WebLinkAboutAge_HillAPPLICATION FOR SENIOR CITIZEN I couNn � TOWNSHIP � YEAR
PROPERTY TAX BENEFITS
� •� -'• State Fwm 43708 (R919-OB)
Prescribed by the DeDartmer�t af Local Govemmem Financa
File
Information contained in this doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.735-9.
wsrRUCnoNS: pEC 2 `G 2008
To 6e li7ed in person oi by mail with the CountyAUditw ol the county where fhe property is loca(ed.
Filirq Defes: 1) Rea/ Property: Dunng fhe hveNe (72) mrnths befae December 31 0l the year Ihe tleducfion is fo be eflectrtre.
2) Mobile Homes assessed under IC 6-iJ-7 ormanNaciured homes rrot assessed as real properfy.' Dunr�-fjyj� �J�fhs
beloie Mardi 31 07 the year fhe deduction is to be e/fecWe. �� �� � c
SeereversesidelwedddionalinsUUdionserNqualificaGOns. G�BgpNCOUNSY %`UU17�R
Tyoe N Denef.t reQUested (dease Meck aH Naf apWy�
Over 65 Deduction 6om Assessed Valuatlon Over 65 Circuii Breaker Credit
Namedepd' orconfractDUye�
r
Is a itam tha sole lepal or eduitabia naY1 If No, what is his/her exaq share or interest? I! owned with mmaor.e other than spouse,
inditate with whorn
Yes ❑ No
It name rn recorO is dilfe m Nan that of ao�irc'ant, indiwte bebw
Nama ot cont�ad seDer (appOcant musf haw been Ouying on confracf at leasf oiro (1) yea�
Pddreas of mntrad saller (number aM street, crty, sWto, and 2IP wCO) Is ine omoerty in cuestior.:
� Real propery � Mobile home (IC 6-7-7-�
� islnci Ke n mDer / Legal daSCnOtion Racord num' Paga numGer
� � � /3-�G-�d4-aoo.�3o-Ct�
Is Ihe oroDeM useE arW occuoied Ddmany hr Assessed valua ol ihe omoerry as ol March 1, curtert year (may nof ercoeG 5182,a30
hisTher residenm7 :or O�er 65 tlotludion, w 5160.000 br tho Over 65 Circuif &cakei Godi!)
Yes ❑ No
Wa� the aod�m 65 years af a6e w more on Decembar 31 0l the year
Have you (led for any other tleducYions? If Ves, wnat deductions?
Yes � No �s
Hava you fJed for Ceduetions in any oiher cour.ryl It Yes, wnat counry?
� Yes No
IIWe certify under penalty of perjury lhat tha above and foregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ '
/ $gniW/B ot a0d���� ` AdC�ess Of a0plic7�•1 (nvm�cr ar,d strocf. ciy, sfato. and ZIP mde)
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% � � - �9 S. .�t ,= s
� Sipnature d authorized reoresentative ACdress of authorized :eo.resentative (numbcr and s:rcet. ciry, stae, and ZIPCWe)
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