HomeMy WebLinkAboutAge_Kramer"' r. APPLICATION FOR SENIOR CITIZEN
.;. . - . PROPERTY TAX BENEFITS
� ` �; Sble Fortn d3708 (R91408)
Prascnbed by the Department ot Local Govemment Finance
IMormatiom m�tained in this tlocvment is CONFIDENTIAL pursuant W IC 6-1.1-72-9 antl IC 6-1.1-35-9.
COUNTY I TOWNSHIP
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INSTRUCTIONS:
To be fifed in persm or by mail with fhe CountyAuditw o7 the couny where the properry is locafetl. D E C 3� 2�0�
Filiry Dates: 1) Real Property: Dunng fhe fweNe (72) marths before Decem6er 37 01 the }aar the deducLOn is fo be eHective.
2) Mo6ile Hwnes assessed under IC 64. 7-7 or manu/actured homes not essessed as real property: Dunng Ne fwaNa (j.2)�onths
be(ore Maich 37 0l fhe year the deduc6on is fo be eHec6ve. �B� r43 /J/� �
See reverse side fa addifional insLuctions arM qualifications. UNTY AUBIfi@
..�ncf1N CO
Type oi CeneH rapuest (please rhack e0 Nal app/yj
�Over 65 Deduction from Assessed Valuation
Name
� U r� .
Is aoolicam t e sole legal or aquitable oxna(1 If o
Yes ❑ No
it name m record u diflar . t ihan Nat of epp6cent i�dicate bebw
Name ol cont2ct seAer (appGwnt mus! hare Daen buying on cmt
Pddress W contratl seller (number eiH sWet,
� Tazi dist�
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Is �ha omoeM used and occupiad
hisrTer residano7
and ZIP rotle)
share or
Y��
Wer 65 Circuit Breaker Credit
umDer / legal tlascnotia�
-l�a�-,.�-c�9. ��9
❑ Yes ❑ No
Waa the epplicarit fi5 years ot age or mwa on December 31 ot tha year
o�or to the wrrent yaaR
� Yes ❑ No
Adjusted gross ineome of applicant, spouse, and any
individuals sharing ownership (Fo�Over 65 deduction, income
may nof exceed 525,000; lor the Over 65 Cirwit Breake� Credit,
income may rrof exceed 530,000lor individuals, or 540,000 for
manied carples).
Have you filed fw ary other deductions7
Mava yau fileO fw dadvaions in any
Yes � No
Yes ❑ No
Pssessed value of the on
br 0`e/ 65 tladucfion, a
If owned witn wmeone other ihan soouse,
indicate with whom
orope�ty in ouestion:
� Real property � Mobile home QC 6-74-�
Record number Paye rumber
�1POliranfs dale of biM (mon:h, day, yoar)
lncome
If Yes, what deductior.s?
If ves, wnat
�.h 1, curtent year (may not erceed SfB2.d30
� Ovcr 65 Circuit &eaker CreCit)
If filea by a surviving, unmamed spouse,
what was the spouse's age al iha time
of deatr.?
� Amount of Income
IS
IS
TOTAL I S /()oi6 � �—�:A9�—
I/We certify under penalty of perjury thal the above and (oregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 �
/ $ipn2luR ol ep�caM . � AEdress of a001irar.t (numberantl stroct, ciry, sta;e, antl ZIP code) / "
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Signaturaof "z
arM sneel, ciry, sfafG, an7 ZIP cade�