HomeMy WebLinkAboutAge_SullivanAPPLICATION FOR SENIOR CITIZEN couNrr TOWNSHIP � r�
S .,. , !. PROPERTY TAX BENEFITS � � �"'!
Sta� Form 43708 (R9 / 9-08) ��1
� Prescnbed by the Depertmem of Lacal Go�emmem Finarxe �.-�
File Mark
Informatiom m�iained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC Crt.t-35-9. N QV 2 3 [��u
INSTRUCTIONS:
TO 6e filed in persm or by meil witA the CountyAUtlita of fhe oounty where fhe property is locafed. �a'fJ�. �
filing Dates: 7) RealProperty: Dunng the tweNe (12) monfhs before Decem6er37 o7the ysarfhe tleducfion is to be efrecti[d.
�.���7 �1�pITO
2J Mobile Hanes assessed under IC fr7.1-7 or manu/ectured hwnes rrot essessed as real propGrl$Sni Airgmre�wel�e'(i�(mon s
befws March 37 o/the yea� fhe tleduction is fo be ef/ective.
See reverse sitle /a atltlifional instnidions erMQUalifications.
Type W benefit repue5etl (please Mxk e9 Nat epply)
� Over 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Name o( apd�rt (ouxrer a con4ad bvyaQ �
Is apoGmrtl the mle lepal oreQUitada owneR If No. wnat ia his�har ezad share w intarest7 H owned with someone olhar Ihan soousa,
indifate with wtrom
❑ Yes ❑ No
tt name on remfd is ditfarem than that d eppfimnt, iMicate bebw
Nama of cwrtaa se�er (app�rcant mvst hava Deen buying m canfrea af besf orre (1) yoarJ
fddress of contran satler (nunber and sbeot ci(y, s4fe, and ZIP mde) �s the D�DDBRy in puesiron:
� Real property ❑ Mobile home (IC 6-74-�
� 7axing istocl Key num6er / Legal description Recortl numbar PaBe numher
��e-iQ,,� b ��y�/`_Dl-ool:_29.lo=o.z
Is the pmpeM used and occupeC primarily lor Assassed value of the property as of March 1, wrtent year (may rrof arrnoE 5182.a30
hisRiar rasideno7 !or O�er 65 tlatluction, w E 160.00D Ior Ne Over 65 Ciic�if &oekor CreEi�
� Yes ❑ No
Was Ihe aDW�m 65 years of ape w more on �ecember 31 of the year .
� what was the spouse's ape at �he time
�YBS ❑ NO � / o(dea�hl
Adjusted gross ineome of appliwnt, spouse, and any Source ot Income Amount oi Incoma
individuals sharing ownerehip (FOr Ove� 65 deduction, income S D
maynotexceed525,000;for7heOver65CircuifBreakerCredit, %dOQ /O �/� � .S�l
income may not exceed 530,000 for individuals, or 340,000 Ior �
married couples).
TOTAL 5 0.00
Have you Hed fur ar.y ofher dad�ctirns7 1(1§s, whal deductions?
� Ye5 � Na �� 5 � .
Hava you filad for deductions in any olhar cwrrty7 If t§s, whal counry?
❑Yes ❑No
IIWe certify under penalty of perjury thal the above and foregoing information is lrue and cortect and thal the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 _
Sipnature of appl'ram AdEress of eoP��mr,f (numbeia�W stroN. ci,y, stafe, arM ZIP wde)
?` 3 � (� (� w l � n � � � C-e �� /v �i
� Signature of auNOAzetl rapreseMative Address of authorized reo�sentativa (number and s.reet. ciry, statc, and ZIP co0o)
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