HomeMy WebLinkAboutAge_BatesAPPLICATION FOR SENIOR CITIZEN � N T iIP I venrt
, PROPERTY TAX BENEFITS "
Stab Form 43708 (R9 / 9-08) �
�` i., � Presaibed by the Depa�mern of Loral Govemmanl Finance
Infwmatiom m�taineE in this doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC &1.7-35-9.
FEB �L � e Mark
INSTRUCTIONS: `�%/�.� ,Li+��}
To 6e filed in persm or by mail with the CouMyAudifw o/ the county where fhe property Is located. d� v
Fding Dafes: 7) Reel PropeAy: During the hveNa (12J mmfhs 6efae Decem6er 31 of the year the d�g�0�k G���c�up�TOR
2) Mobile Homes assessed urnler IC 61.7-7 o�menufectured homes not assessed as reel property: Dunng the hveNe (12) months
6e/ore Mardi 37 olthe yearfhe deducUon is fo 6e eNective. �
See ieverse side for edtlitional insWdions errd qualificalions.
Type of ba�refit reaueated (deaxe MeUc eID Nal ePply) •
Name
sale legal or
If name on recortl is
Ta�irp
Is Ne C
hiSRier
9ver 65 Deduction 6om Assessed Valuation
co�r�-aa DyeO
❑ No
berow
mmaa zanar /apuara�r m�i naro eee� cUy�np m cmuaa
seller (numOeraM sDSet ciy, stab,
br
Keynum6er
Over 65 Circuit Breaker Credit
�er exact share or i�teresl?
orw (�lY��
I XI Yes ❑ No
T
VJas the appfkeM 65 yeers of age or more an D mbar 31 of ihe year
o�<<o Ne artent yea(I K�f
� Yes ❑ No
Adjusted gross Income of appliwn4 BPouse, and any
individuals sharing ownership (FOr Over 65 deduction, income
may nof exceed 825.000; !or the Over 65 Circuit Bieaker Credit,
incane may not exceed 530, 000 fo� individuals, or 540, 000 fw
married couples).
Hava yau (da0 fur arry Wher dedurams7
❑ Yas �No
Have you filad fw deductions in eny dhe� wuMy?
� � Yes � No
H owned
indifate
o�ooerty in ouestbn:
Ihan spouse.
�eal pmperty � Mobile hwne (IC 6-7-7-�
Record number Paga r,umber
Assessed valua of lhe WoDerty as ot March � wrtenf year (may rrof exccetl 5v82.<30
lor O�er 65 dotl�Cim. or 5160.000 /or the Ovcr 65 Circuit Broa.Vw CroCi�
.� �.�,
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and cortect and lhat the applicant was a r@sident
of Indiana and owner of the aforementioned properfy on March 1, 20
Sqnetura of applicaril P.dtl�asa of aDG��'am (numba en0 sboeC �y. sbte, an0 ZIP code) ,
�"' �� 0.n,.�
SigneturedaNhorizad
AddresaofaultmrizadreD�sentatrve (numDera�MSLCa4
end LP coCa)