HomeMy WebLinkAboutAge_BrownAPPLICATION FOR SENIOR CITIZEN
- . PROPERTY TAX BENEFITS
� �' Stafe Fortn 43708 (R9 / 448)
� Presvi6ed by Ihe Oepartment of Local GoeemmarH Finaxe
Mformetiom m�tainetl In this doamenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.L3S9.
COUNN TOWNSHIP � YEAR j
{ File Mar
APR282010
�NSrRUCnoNS:
To 6e filed In person or by mail witA the CountyAuditw o/ the county where the property is locafed.
Filing Dates: 1) Real Property: Dunng fhe fweNe (12) mmths 6e(ore December 31 of Ihe year Ute deduction is to be e�Nentt �
2) Mo6Ne Homes assessed urMer IC 61.1-7 or manu/acfure0 homes rro( essessed as real property: �.�y�u�+ s
6e(ore Merci� 37 07 the year Ne deduction is to be e!lective. ��fi��
See ieverse sltle la atltlitional insWdions arM qualificatims.
Type d be�ref.t reGUes2ed (pease Meck a➢ Nat appl�
Over 65 Deduclion 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name of e cam /owra. «oo,r��x e�ye�
is aooi�am u,a sde iapai or ea�naaa w.,,an H No, w�at ia his�her exad ahare w interesl? tt ovmed with mmeone oi�er t�an spouse,
indicate with whom
Yes ❑ No
II name on recoitl b diflereM ihen Ihat ot apqirenl indiwte bebw
Name of contrecl seller (epplicanf musf fwve been Duyiig on cmllaG a! basf orw (1) yea�
Pddrass ot oontred seller (m�mba arid streaC city, sbte, and ZIP code) Is t"e v�oerry in auestion:
�Real pmperry ❑ MoDile homa (IC 6-74-n
� Taz4g distrid Key number I legal EascnIXbn Record number Page num6er
� - ,.35� aa-aoo./4s� �ai
U Ue ropeM us M ottuDieO � arily (or Assassed value ot lhe Oro�erry as ot March 1, wrtent year (may rrof exceed 5182.d?0
hiarha residenm .�y /� lor Orer 65 deduGron, ar 5760.000 /or No Owr 65 Cw�cuif &oeker Gedi�
R I Yes ❑ No
CZ
Waa Ne eppli�srM 65 yeais of age or rtroea on Dacember 31 ot the year
Hava you (ded for erry dher deEuctions? If Yus. what deductions?
❑ Yes ❑ No
Hava you fJed M OeducCOns in any othar courrty? I I(1gs. wtat counry?
❑ Yes ❑ No
IIWe certify under penalty of perjury that the 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 t, 20 -
Sipnature of epqicaM P.dtlreaa of aDP�ipm (numbere� streef, ciy, sfafe, aM ZIP code) :
ir yp,�v°�S �SG�C� Gd��-�.� �7�G�
Sipnature d authMzetl rapreaerrtative MOaae of eWhaizad representative (numberantl sLOef, ciry, stafo, end LP cotle)