HomeMy WebLinkAboutAge_Lee (2)" APPLICATION FOR SENIOR CITIZEN couNn T HIP r i
� -. , PROPERTY TAX BENEFITS
Stab Fortn 43708 (R9 / 9-08)
� ie � Presaibed by ihe DepartmeM of Loral Govammertl Finance
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Informstion cootaineE in Nis tlowmenl is CONF�DENTIAL pursuant to IC E1.1-12-9 and IC 61.1-35-9.
INSTRUCTIONS: �a<., ��, Q ��
To be filed in person or 6y mail with fhe CountyAuditw o! Ne county wAere the property is locefed. �;� Gn Q �
Filing Dafes: i) Real P�opeAy: Dufig the fweNe (12) mmths befpe Decembar 37 o(the year the deduction is to be eifeBcCN4N COUNTY AUDITOR
2) Mobile Hames essessed uMler IC 6-7.1-7 or manWacturetl homes rrot assessed as real properiy: Dunng Ihe hveNe (12) months
be(we Marrh 37 0! the year the deduction is to be eRecfive.
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See reverse side for addd'wnel insWdions an0 qualifications.
rype d eaoef� r�o�amaa W�� mod ee wa� ecWN � /
M name on racord'u diRe�eM Nan thal d eppf�nt i�Wi�ate bebw
Name af mitrzG seller (applcenf musl Aare Dem b�ying m conLaq ef /aest oire (i) yaah
Address ot contrad saDer (num0or aM stroe4 cly. stete, aM ZIP mde) Is iha pmoe(ty in auestion:
Real property � Mobile home (IC 6-7-1-�
T�'ug Eistrid Key number I Legal Eascnption Rer,ord number Page r.umbar
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la ihe O�CaM used and accupiad primaAty br Assassed value ot the DmOeny as ot March 1, wrtent year (may not exceed 5182.d30
hivher rea'Nenm? !or Orer 65 dodurlion. or f 760.000 (or Ne Ovcr 65 Circurt 6ioaker CrediQ
Yes ❑ No
Was lhe eOD�m 65 years of ape a mae on D mber 31 U Ue year
Have you filad tor arry other detlucGms7 If Yas, v.�hat Cedudions?
� Yes ❑ No
Have you f�ed ta deductions in eny other cowriy? �� �bs, what counry?
� Yes ❑ No
I/We ceAify under penalty of perjury lhat 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 1, 20
Sipnalu�ppficarrt � pddrasaofaDplimr.t (nwnOwaiNStroef.tiy,sfare,aiHZ/Pwde)
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S�gnaiure of aNhonzed ieD�s¢ja�a Mdress ot aulhodzad reo�esenta�ive (numGer arM sueet, ciry, stato, and LPcoda)
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