HomeMy WebLinkAboutAge_Massa;� APPLICATION FOR SENIOR CITIZEN
;.'.• 4 PROPERTYTAXBENEFITS
S Sbte Fortn d3708 (R919-08)
� Prascnbad by the Oeoartmam of Local Govemmem Fir,ance
Intormation contained in this tlowment is CONFIDENTIAL Wrsuant to IC 6-1.1-72-9 and IC 6-1.7-35-9.
COUNTY � TOWNSHIP � YEAR j
��I�J�
File Mark
DEC 2 6 2008
INSTRUCTIONS:
To 6e filed in person or by mail with fhe CountyAuditor o/ fhe counry where fAe property is located. '-�y��! a ��
Filing Dates: 7) Real Prvperty.' Dunnq fhe tweNe (12) months be/we December 37 0l [he year the deduction is fo be et7ectrve.�' �
2) Mo6ile Homes assessed urMer IC 6-1.7-7 or manu/actureC homes not assessed as real properf¢�YIG���i�f �h�R
be/ae Mardi 37 o/the year the deduclion is to be eHective.
See raverse side /w adddionel insWclions and qualifications.
TYpe ot beneH reQUested (pl so rheck eC fhat appyj
�er 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
"�
NemB of applicaM (Ownor P' ca�trdct DuyoQ /
CJ ,d�-�- 7�`�'.�� ,
,
Is a lipnt the e legal or epuitable owneR t No. what is nislner exact share or inte:est9 R awneE 'tF someone other Ihan soa:se.
inditate witn w`om
❑ Yes ❑ No
11 name an record ia diflarent tlian Mat of ao�nt ��diwte 6ebw
seller (apd��nt musf haw Daon buying m
�
Pddress of mntratl seller (num0er arM sbeef, ciry, state, a� ZIP co0e)
Y�7
T�inq Oistncl Kay number / Legal CescnOtion
Q,�--� o21�-a3-r(�-5'00 -o0/.�oi<
�
I�Ne o�ooeM used and oaupiad orimany br I Assessad value ot ine �v:
hisRier rasidante? !or Owr 65 tlotlucfion, w 5
Yes ❑ No
VJaa the apoli�am 65 yean of aga w more an December 31 d tha year
o�� to Ihe wrrem yea(!
Yes ❑ No
Adjusted gross ineome of appliean; spouse, and any
individuals sharing ownership (For Over 65 deduction, income
may not exceed 525,000; !or the Over 65 Circuit Bieaker Credit,
income may rat exceed 330,000 for individuals, or 540,000 for
married couples).
Nave you filed for any Mher deduGionsT
� Yes ❑ No
Hava you filed for deduCions in any aher counry
� Yes � No
a o�ooarty in cuestior::
� Real prope .ry � Mobile home (IC 6-1-7-n
IRecord number Paga rumoer
�D J- �
March 7, cur. ant year (may not erwoC 5182,a30
�r Ne Ovr/ 65 C'vcui! &eaker G2�7i� ; '
IIWe certify under penalty of perjury that lhe above and foregoing information is We and correct and that the applicanl was a residenl
of Indiana and owner of the aforementioned property on March 1, 20
ureofaopficant PGEressolaoG��am (numDerandsbeet,d.y.staro.andZlPmde) � /,
CGL<-G
, lr�-,�%ia�— � ,� �/ �/,� 6 1/li� „., � _ _ ��_ f�� y��
d afi6�onzed reoresantative
Addressofauthorizec:ap:esentalive (numberarMS:meCCiry,state,andZlP
`I