HomeMy WebLinkAboutAge_Baker" APPLICATION FOR SENIOR CITIZEN
- . PROPERTY TAX BENEFITS
State Farm 43708 (R919-OB)
�`�•� � Prascn6ed by U�e �eoar4meM of Local Govemmerrt Finance
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� UN INSHIP � YEAR
A R 1 6(���File Mark
Infortnatiom m�tained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC G1.135-9. .
INSTRUCT10N5: /�
To be filetl in person or by mail with (he CountyAuditw o1 the county where fhe property is locatetl. �~�
Filing Dates: 7) Reel Property: Dunrg fAe fweNe (f 2) months be%re Decem6er 37 o7the year (��Mi�p1Q�IHdqp�pR
2J Mobile Homes assessed urrcler IC 6-7.1-7 or manulacturetl homes rrot essessed as real pioperty: Dunng fhe tweNe (12) monNs
be/ore Merch 37 0l fhe year the deduction is to be e/fec6ve.
See reverse sitle lor eddAionel insWCfions aM OualificaGms.
Type of 6enaf.l rapuesied (peaso Mxk e➢Nat appl�
� Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credii
Name ot aO�Kam ( a Can4att euy9Q
Is aoolimm the sole lepal or eVUiteMe amerl I No, what is hislher ezad s�are or interest? tl owned wi�h somaone oi�er than s0ouse.
indicate w�th wtqm
❑ Yes ❑ No
If name on recoN is Cifleient I�an Naf M eDdiran� indicata below
Name ot mni2cl se�er (eppficanf musf Aare Daon D�yinp on conLatt ac leasf orre (7) yea�
Address of mntrad seAer (mmba aM sbaet, r�ly, state, aM ZIP wde) Is ihe o�oe`ty in auestion:
� �yeeal pmperty � Mobile home QC 6-74-�
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Tazing disinG Key number / Legal description Record number Page number
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la the p�operry used arM ottu0�ed primanly br Acsessed value of ihe properry as of March 7, wrrent year (may nof erceed Sf 82,d70
hiNher residenw7 lo� O�er 65 tlotlueion, n 5160.000 lar Ne Over 65 Cticuil Breaker CreOin
� Yas o Na
VJas lhe aOW�M 65 yean of age w mora on December 37 of lha year
Have you fded fw arry othar daducCOns7 I It �bs. what daductions?
�Yes � No
Have you fled fw deductions in any olher cwnry7 It 1es, what wunry?
�Yes ❑ No
IIVJe certify under penalty of perjury lhat the above and toregoing information is true and correct and thaf lhe applicant was a resident
of Indiana and owner of the atorementioned property on March 1, 20 _ -
SignaturaNa�xicarM1 Pddtassotapplimnt (numborenCStroe(,ciry,state,ardZlPCOde)
!`' �•�/ Sa �.cC7-�trt. �..e_ � � �76tf�
Sign re W onzed rapreseni ' e AEdress of authoAZeE re0resentative (number aM sbee4 tdy, state, and LP code)
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