HomeMy WebLinkAboutAge_Masona APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR i
� S ,rt-'. PROPERTY TAX BENEFITS �
Sbla Fortn 43708 (R9 / 9-08)
P`escnbed by Ue DeDaMment ot Local Govemmerrt Finance
e Mark
Information contained in this document is CONFIDEN7IAL pursuant to IC 6-1.1-12-9 antl IC 6-1.135-9. � y�oo$
DE� �
INSTRUCTIONS:
To 6e filed in persm or 6y mail witA the CountyAUditw ol the �unty where fhe properly is Ixafed. ��,
Filirq Dates: 1) Reel Property: Dunng fhe hveNe (12) months be%re Decem6er 37 0! the yea� the tleduclion is fo be eHec�p� �
2) Mobde Homes assessed urMer IC 6-7. 7-7 or manNactured homes rrot essessed as real pmperty: Dunng Ore,tC�y�(�1eJ(ni9i����R
6e/ore March 37 0/ the year fhe deduction is fo 6e eHective. GIBS
See ieverse side fw add'dional inSWUions arn1 qualifications.
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Y.f]
ryoe a teoen rea�as2 (d�se meck en n,n� avvA�
Over 65 Deduction hom Assessed Valuation Over 65 Circuit Breaker Credit
Name d epuGnrrt ( or contracf DuyoQ
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Ic ao0litarit the wie legal oreavitabia owneR If No, whal is nislner esad share or interest7 If owned vntn mmaooe oNer than spouse,
mdirata wiLh whom
Yes ❑ No
If name on �d is diRa 1 Nan Ihat ot aodifa�l �ndicate bebw
Nama o1 con12G seller (apdicant must haw beon Ouying m cm✓act at least ox (i) yea�
AdOIB99 01 mt1C2d SBIIB� ���R168/ dIH 54B¢f, Cil)t SfdfO, eOC ZIP �db) Is ihe o erty in auestion:
Real property � MoDile home (IC 6-7-7-n
Tazing - ntt Key num6er / Legal descnotion I Record number Page number
G �aas-/�-�n/.a�.�-c��
Is t�a O�DeM used anC occu C orima for Assesse7 �alue o( the omoeKy as of March t, cur.er.t year (may rwf erceed SiB2,e3G
�isrher rasidenw? for Owr 65 tladuaion, a 5160.000 for the Over 65 Circuif Broaker Crtdi�
❑ Yes ❑ No
Was the a0d�wn165 yaars o( age or more on December 31 d tna year
/� � o(aeati?
Adjusted gross ineome of appiicant, spouse, and any � Source of Income � Amount of Income
individuals sharing ownership (FOr Over 65 deduction, income I 5 I
may not exceed 525, 000; lo� the Over 65 Circuit Breake� Credit,
income may rrot exceed 530,000 (or individuals, or 540.000 for I 5
manied couples).
TOTAL I S �
Hava you fled for any othar deduc6ons? If Yes. wnat aeductiors?
Yes �No S•� � —
Mave you fdad for Ceductions in any ot�er courrty7 If `!es. wnat county? ,
� Yes ❑ No
I/VJe certify under penalty of perjury lhat the above and foregoing informalion is We and correct and that the applicant was a resident
o( Indiana and owner of the a(orementioned property on March 7. 20 _
SignalureNeppGcam �PEtlressotaDp�i�nt (numberandsWet.ciry.slaie,antlZlPwde)
��i -�? a.� e 7 .0 �-f' v/�dL �iL-�-=� �Ze-w
Siqnature of authodzed reoresemativa Address af authonzed rawesenfatre (nomDOr and s:reet. ciry, 5a:e, and LPCade)