HomeMy WebLinkAboutAge_AlmonAPPLICATION FOR SENIOR CITI2EN CO .TOWNSNIP ' VEAR
. PROPERTY TAX BENEFITS ; s;
f Sfate Fortn a3708 (R9 / 408) % '
�S uu � P(awibed by the Departmem of Local Govammem Finaxa y ��� ��� '
Infartnatiom m�tained in Nis doamenl is CONF�DENTIAL pursuant ta IC 6-1.1-12-9 and IC E7.1-35-9. JS �F. Je AAa4c 2009
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INSTRUCT10N5: ,(��
To be filedln persm or by mail wHA Ure GountyAuditor olfhe county wAeie the property is locafed. ���a '�' jj�
Filirg Dates: 1) Real Piope�ty: Dunrg the AveNe (72) matths befwe December37 olthe ysarthe deduction is to¢�e�ercf�L�GUNTY AUDITOR
2) Mobile Hames assessed uMer IC 6-f.7-7 o�manulactured homes rrot assessed as real property: Dunng fhe fwsNe (72) mrnfhs
6e/ore March 37 of the yeer Ne detluctlon is to be elfecfive.
See reverse side 7or adddional insUVCG"ons arM qualificelions.
Typa of benaft reQUested Wleaso rhack a9 Uwf apply) ' /
Over 65 Deduction hom Assessed Valuation Lg.Ovar 65 Circuit Breaker Credit
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Name d ap�lircaM (ow�r a cronf2cl buye�
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Is applimrit the sda legal or ea WWe owneR If No, wh i er xaq ahare w interesl7 If owned with someme other than soouse.
iMiate with wtwm
❑ Yes ❑ No
tt name on record ia diRarem Man thal of appfiranL Indicate bebw
Name d conirad seller (appl'mant musl Aare Eeon buyirp m cartract at laeat orre (i) yearJ
q/dd�re�ss af mpntred setler (number aMabae; ci(y. stele, eM ZlPcode) Is lha o�oefty in Question:
)C' l» V7�.:1-G'7 � 51 k�oxm� �-1 � Real Droperry ❑ Mobile home (IC 6-7-1-�
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� r��np e�s�ria Key number / Legal desaipiian Record number Pa9e number
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Is Ne pmpeM used anE ocwpied pAmady br /+ssessed valua ot Ne pmverry as of March 1, cunem year (may irot excea0 St82,a30
his/ner rasidenw7 br O�er 65 deduCiai, a 4760.000 Por fhe Owr 65 Circuif &oakar Credi�
es ❑ No
Was the epWicam 65 yea's ot age w more on December 31 of the year AGD����'s tlate of bitlh (monN, day, yoeQ If fled by a surviving, unmarried s0ouse,
oriorto the arram yeen what was �he spouse's apa at the t'une
❑ Yes ❑ No oreeama
Adjusted gross income of applicanR BPouse, and any
Have yw filed for any Wher daduclbns9 It Ws. what deduNons?
❑ Yes ❑ No
Have you (Jed for EeEuctians in any other courrty9 II Vea, what ca�My?
� Yes ❑ No
IIVJe certify under penalty of perjury that the above and foregoing information is true and correcf and that the applicant was a resident
ot Indiana and owner of the aforementioned property on March 1, 20 _
$ignaturedappficarit PddreasotepDlimnt (numbaerMStroot,ciry,sGte.a�MZ/PCOdo)
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� SgnaN af aulhonzed reD�aseMativ MQatga of eutlrorized reoresanWtive (numboran ciry, s�fate, entl LP codo)
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