HomeMy WebLinkAboutAge_Hyneman� "' a APPLICATION FOR SENIOR CITIZEN courun � TOWNSHIP � YEAR
, - . PROPERTY TAX BENEFITS I
S � J Spte Fortn 43708 (R919-OB)
PrexAbed Ey Ihe DapaM1meM of Local Govemment Finarce
,.�. �a�j �
In'ortnatbm m�tained in this tloament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61.135-9.
INS7RUC710NS:
To 6e filed in persm oi by mail wflh the CountyAutlitor olthe county where the property is located. 1 g�000
Filing Dafes: 1J Real Property: Dunng the tweNe (72) months be%re December 37 o/fhe year fhe deduclion is to be eHecfE � 1 0
2) Mobile Hanes assessed under IC 61.1-7 ormanulacfured homes not assessed as reel property: Dunrn] the tweNe (12J monG�s
r1
L� J
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before March 31 07 the year the deduction is to 6e affeclive. OQp.�„ �Q�
Seereversestle7aaddifionalinsWdionsandqualificafions. GIBSONCO �
Type o( benefit repueated (ploeso chack a41�ef appg�
Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name Ot aoo��1 /oM'ne/ 4' cont2ct OuyoQ
n2 ' 2
Is apolimM the sole legal or epuita e aR If No, what is � s/ner exacl share or ir.teresl7 If owned witn wmeone other than socuse,
�51 Vldl('d�B WII�1 N'�IO:II
y�-�'es ❑ No
� If name on record is C'ifle�ant Nan that d aod&'zn4 inCiwte cebw
Nama of cont2d selter (epW/cant musf haro been buyirg on cm✓ac1 at Mas1 one (tj yea�
Address W mntretl eeller (num0er erid s✓eet. cily. s3te, and ZIP code) Is ihe orooerty in cuesiion:
�eal propery � �dobile home (IC 6-74-�
T�ing Eistnd Key number / �egal Cescnotioa Recortl numha: Page r.umber
�, a�-i�-��-��,-co�.� 9-c��
�
Is Ne O��eM used and occupied o���N br Assessed valua ot Ihe Drooerty as af March 1, curtent yezr (may not exceetl5182.430
hisllier residence7 !or O�er 65 dotluaion, or 5160,000 /or the Ovoi 65 Circui[ &eaker Credit)
❑ Yes ❑ No
Was Ihe epplica^i 65 years ot age w mwa on December 31 of lha year
Hava you lled fw a.ry othar deCuctior.s7 If Ws. w�haf deductiors? ,
�s � No `
Have youlJed fv OaEUCGOns in any dbar counry7 iF Yes. wnat counry?
� Yes I JF�No
T
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned p�operty on March t, 20 _
Signature W apd��� Address of aoO��N (num0er antl snoct, ciry. slato. and ZIP wde)
r,�,(� � I� /OG70 � �� �
Signature of euthwized reorese tatrve AEdress of authorized reoresentative (number antl s;mef, city, sta:e, and ZIP code)