HomeMy WebLinkAboutAge_Harden (3)� "' A APPLICATION FOR SENIOR CITIZEN
� . - = PROPERTY TAX BENEFITS
S - f• SfateForm43708(R9/408)
Prescnbed by Ihe DepertmeM of Lacal Govammem finance
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Infwma[iom m�tained in lhis doCUment is CONFIDENTIAL Wrsuant to IC 6-1.1-12-9 anE IC 6-1.1-35-9.
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COUNN TOWNSHIP I Y� I
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MAR 17 2011
To be filed in person or by mail with fhe CountyAuditor o/ the county wfiere the propeRy is locatetl. C. �,
Filiry Dafes: 7) Real Property: Dunng the fweNe (72) months belore December 37 o7lhe year the deduction is to be eR
2) MobNe Homes assesse0 urMer IC G7.1-7 or manulactured hpnes rrot assessed as ld�� � e (72) months
be�ore Mart,i� 37 o/the yearthe tleduceon is to be eHective. AUDITOR
See reverse side fa atltlitional insWUions arM qualihcations.
TYGaWbetref.i'aCUe9ed(P�eas otke➢IhalaOPfYI
er 65 Deduction 6om Assessed Valuation Over 65 Circuii Breaker Credit
Name of app�KaM (ow+�ar a cmbacf EuyeQ
Is applimrtl tha sole legel or epuitebl e(! If No, what is hisRier eaad share or interest9 N owned with someone Wher Ihan spouse.
intlicata with whom
es ❑ No
tt name on record is diflaraM Man Wt of eDd��t indiwte heb«
Name of mntaa se�er (eyp'rcent must heve beon buyirg m conrraa af bast om (t) yea�
Pddrass of contratl setler (numDar end sbee; tity, s6fe, aM ZIP code) - Is �he pmoerry in Question:
� Real pmperty ❑ Mobile hwne (IC 6-14-�
Taxing tlistAq Key number I lepal deacnPlion Record num0er Paga number
- a- i-�on.�v
Is �ha o�OeM � end omped 'mariy (or Assassed value of lhe properry as of Mamh 1, wrtanl year (may nof erceetl57H2,a30
hiNher residance? kr Owr 65 tletlucfim, a- 8160.000 for No Ovor 65 Ciicui( Bmaker Credi�
es ❑ No
Was tha appGpm 65 yean of ege or rnora on December 31 ot e year
Have you filed for eiry other deductbns? It Ws, what deductions?
❑ Yes ❑ No
Have you fJed fw deductiona in eny other cauerty7 I( Yas, what couMy?
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing information is We and cortect and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 _
Signat ppGCam MER390taDDli�n� (mimberaMSwot,ciry,stata,arMZ/PCOdo)
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Syn ure of authorize0 rep aentafre ress of euthoriza reoreseniative (numDer aM s' , ciry. 9afe, anC LP c e
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