HomeMy WebLinkAboutAge_Hyneman (3)APPLICATION FOR SENIOR CITIZEN cou ,(IOW SHIP , 1`EA
PROPERTY TAX BENEFITS '
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�Sdta Form 43708 (R919�08�
� �u � Prswibed by t�e Deoanment of Local Govemmant Fc�ance
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Information contained in this dowment is CONFIDENTIAL pursuanl to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: �G,,,, �C�
To be filed in persm or by mail wifA fhe CounryAuCita o/ the county wFtere the properry is located. O G�
Filing Dates: 7) Real Property: Dunrg tAe fweNe (12) months before December 37 ol(he yea� fhe detlucfion is to b�:Pea(� COUNTY AUDITOR
2) Mobile Hwnes assessed under IC 6-7.1-7 or manulacfureO hanes no( assessed as real pmperty: Dunng fhe h+relve (12) months
be(ore Marrh 37 o7the year the deducUOn is to be e/lecfive.
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See reverse side /a atlddional instructions and Oualificafions.
Type ot Oenefit raQUested (Woaso Mack aOlhaf appty)
�Over 65 Deduction from Assessed Valuation Over 65 Circuii Breaker Credit
Nama W apoGCarit (rnmer w cmtracf b�yo�
is aoolitarit th¢ wl al or epuitabla owneR If No, what . IFie xad sha:e or intarest7 If owned witn mmeone othe� Ihan spouse.
indicate with whom
�es ❑ No
It name w+ recad is diflarent ihan that of aod;cant indirata below
Nartre of contrac] saller (applicant must hzvo Docn Euyirg m canfract at Masf ono (7) yearJ
Address W contrad sel!er (numbor aM sneet, cry, state, aM ZlPmde) Is tna omoerry in oues�ion:
eal prope ,ry � Mobile home (IC 6-74-�
Tazing Oatnct Kay number / le9al Casu� ion Racord numher Page ru:nxr
�t�-65- s'�- I\9 -aoo .
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Ls fhe pmpe(fy used and ocwped ny br Assessed valua o/the roDerty as of March t, curtent yezr (may rrof erceeE 5782,a30
his/nar resiOence? 7or O�r 65 dorluCion, w 5160.000 for Mo Ovw 65 Circuit &oakei Crtdi�
Yes ❑ No
Was ihe aoGlican165 yeare of ege or more on December 31 W the year Aopii�nt's date oi birth (month, tlay, yearJ if flec by a survivin9. un.mamed soouse, I
prior to the airreM yea(1 what was ihe spousa's zga at Ihe time
�5 � NO of dexth?
Adjusted gross ineome of appliwnR spouse, and any �
r��e ya, eiaa ror am omer aae��o�n It Ves. what dacuctions?
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Hava you fJed for tleducUOns in any other counry7 If Yes, whaf wunry?
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INVe certify under penalty of perjury that the above and foregoing information is true and correct and lhat the applicant was a resident �
of Indiana and owner of the aforementioned property on March 1, 20 _ .
Signatu�DM��1 Accress ot a0olirant (num0erand sveet, ci�j, sfaro. and ZIP code)
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5 nalure .on reoresen ative crass authwizec rea�asentati (� nvmborantl s:ree/f, a/ry� s/ate, antl ZIP codc)
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