HomeMy WebLinkAboutAge_Ellerbrook�� � ' APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
� ' Stafe Fortn 43708 (R9 / 408)
PrescnbeE by iha DeparimeM ot Local Govemmerrt Financa
Information oontained in t�is tlowmen� is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
COUNN, TOWNSMIP � YEAR j
a
wsrRUCnoNS: JUN j ] 2009
To be fi/etl in persar oi by mail witA the GountyAudifw o/ the county wAere the properryls located.
Filing Dates: 1) Real Pioperty: Dunng fhe twefve (12J months belore December 37 o/fhe year the deductron is�,;�¢c��.�y
2) Mobile Havnes aaessed uretler IC G1.1-7 or manulecfured homes rrof assessed as re /�tDU�{�; Du� Ne hve�fJU (72) monMs
be/ore March 37 olUre yeer the tleduction is to be eHective. °S"" COU�JTY AUDI70R
See reverse sitle M adtldional insWcfions errd qualifitatlms.
Type d heneEt reawste0 (please Meck e9 Nat applyj
Q Over 65 Deduction from Assessed Valuation � er 65 Circuit Breaker Credit
Name of aDP���1(ownor ar canhac! Du)eh
�0.ro ��/{'� L . C ��er 6�rool�
Is ap0���� �ha sde I I or eQUitaWe ownaR I( No, whai ia hisRier exatl share or inta:ast7 H owned with some�
� Yes ❑ No
tl nama on recoN ia dilferenl ihan Ihat of aodiranl indiwte hebw
Name m corrcraa sener (appGcant must nave eeen euy'ug on ca,hact et aast ono (1) yea�
Taz'uq tlistriU
sboei, cify, s61e. aiM ZlP mde)
Key
spousa.
e pIODBRy in Quastron:
� Real properry ❑ Mobile home (IC 61-i-n
Record num6er Page numcer
r� - �-.� - c�� �c �i a i
Is the pmDeM use0 anE oauDied prinwriy for Assessed value of lhe p(opeM as of March 1, wrtent year (may nof axceed 5182,d?0
hiaTher residence? (or Oye� 65 dedaCion. or 8160.000 fo�Ne Over 65 Circuif &oakar Credi�
� Yes ❑ No
Was Iha eoMwertl fi5 yean of ege or rtrora on December 31 W the year
IlWe certify under penalty of perjury that ihe above and foregoing information is We and cortect and that the applicant was a resident
ot Indiana and owner of the aforemenGOned property on March 1, 20 _ -
AEErasaofepPli�r.t (numberandsboel,crt};stafe,aMZ/PCOtla)
, 3`lya N �asc,J P�b-� u�b�
raD�eMative Pddresa of aulMnze�reprasentative (number mw s•reet, ciry, 4att�/andZ1P cotla)