HomeMy WebLinkAboutAge_HaakeAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS \i
, State Fortn 43708 (R9 / &OB) ^ �
� H� � P(asaibed by the Daoanmenl ot Local Govemmem Finance '\�
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0� COUNTY TOWNSHIP YEAR
Fle Mark
Intormetbm m�tained in this document is CONFIDENTIAL pursuanl W IC 61.1-12-9 and IC 61.1-359.
INSTRUCTIONS:
7o be �led in persm or by mail wifh (he CountyAuditor of Ne county wheie fhe properiy is lacated. .
Filing Dafes: 7) Reel Property: Dunig the fweNe (12J marths belore Decembar 31 of the ysar the deduction is fo be eflective.
2) Mobile Nanes assessed under IC 67J-7 wmanulacturetl homes not assessetl es real pmperty: Dunrg the tweNe (72) months
6e/ae Marc� 37 0/ Ne year the tletluction is to 6e eHecfive.
See ieverse side laatld"dional insWUions and qualiBcefions.
Typa d haneN repwsted (please diecic a� U+at appl�
❑ Over 65 Deduclion from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name d epd�M (�+� w mN2cf EuyoQ
� ..
la ao0lica e leqal or eQUilable ameq If No, whaf is hisRier exad share or interestl tf owned with somaona other than spouse.
� intlifate with whom
❑ Yes ❑ No
H reme on racord is Eifterem Nan Ihat d aoo��t indicate bebw
Name of coM2ct seller (appficenl must /wva Ooon buy'vg on confracf at Wast oiro (i) yea�
PAdrass ot wntretl sellar (numDdaM stroot. ciy, sfato, and ZlPcode) �s ��a O�oerty in stion:
� eal property � Mobiie home (IC 6-7-i-�
disind Key number I Legal descnplion Recwd number Page number
� .eL- l t- - �D.� aa -oa�
Uie O�DeM � end ped primanly br
Have you filed br e�ry other deductims4 If 14s, what deductions9 .
� Yes � NO
Have you fJed M deductions in any dher couMy? I If 1§s, what wuMy?
� Yes ❑ No
IlVJe cartify under penalty of periury lhat lhe above and toregoing information is lrue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
$gneture W appficam Pdtlrass of eoGlifam (num0erand sbeef, ciry. stefa, arH ZIP wd¢)
�,� O P2 S/°.C// /3/�. i1/.
� Signature of authorizetl �ePresertla4ve •�esa of aulhonzed rewasentative (numDer aM sbeot. ciry. 4ate. an0 ZIPcoOe) .