HomeMy WebLinkAboutAge_DealAPPLICATION FOR SENIOR CITIZEN
r . .. : , PROPERTY TAX BENEFITS
` — f State Fwm a3708 (R9 / 4081
Prescribe0 by the Departrnant of Local Go�emmem Financa
�q COU T NSHIP YEAR
1
M File Mark
Infortnatiom m�fained in this dowmenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7-35-9.
INSTRUCT10N5: p'/� ��+�"�
To be filetl in person or by mail with fhe Coun7yAUditw o/ fhe county wbere the property is located.(� (�� ��u
Fdirg Dates: 1) Real Property: Durrrg fhe tweNe (72) mrnfhs befae Decem6e� 37 of fhe ysar't�Be tleduc�o�n �S fo be eNeD1�OR
2) Mobile Hwnes escessed uMer IC 6-7.1-7 oi manufacturetl homes irot assessetl as real pioperty: During fhe tweNe (72J months
6e/ore Mamh 37 0/ Ne year fhe deduction is to be eHectivb.
See ieverse side la atltldional insVUCfiou erM qualifications.
TYpe af berreft reQUested (please d+eck e0lhdf BPPM
�Over 65 Deduction hom Assessed Valuation ver 65 Circuit Breake� Credit
Name o( aoD�m (ownef a conhacf ouyerJ �
�
Is aOGlitarit the sole I I or epuilable owneR It No, whal is his/her ezacl share w imerast9 H owned with samaona other than spouse,
�\ /I� indipte with whom
�'Yes ❑ No
n �ame «i recwa is ailLeram aw� uw� m aw�anl inaicete behw �
Name d mmac� seoer /app;wnr muu nave eam, evyhq m caiusa at leaa orre (�) yeah
� Address d mntrad saCer (numoor end streeG ciry, sfele, aM ZIP mde) Is the prooerry in cuestion:
Real property � Mobile home (IC 6f-1-n
Tazinp district Key number / lepal descriplion � Record number Page number
�G-�P-ia-aoo-�s1 a�-�si
le Uie pmperry used and occu0ie0 pnmariy br nssewed vame ot ma wooerry as of March 1, currant year (may not exceetl StB2,<30
hisfier rasiden�7 !or O�er 65 dodudion, a 4f66.000 /or Iho Over 65 Cticuif Broekar Credi�
es ❑ No
Was Ue aDd�M 65 yaars of age or mora on D mber 37 of t�e year
Have you filed tor a(ry other deductiona7 If Y¢s, what dedudons7
�Yes �No
Mave you filed for deductions in any dher county7 �� `�es. what counry?
� Yes � No
I/We certify under penalty of perjury that Ihe above and foregoing information is true and correct and that the applicant was a resident
o( Indiana and owner of the aforementioned property on March 1, 20 . '
� Signature o( applicarit MEraaa of epplimni (numberanC stroe(, ciy, state. ard ZIP coda)
� V✓ /
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Signatwe d authonzed re0�eserrtativa ME�eas of aulhorizad reo�sentative (number aiM 5root, ciry, state, and ZIP oGe)