HomeMy WebLinkAboutAge_IrvinAPPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR i
� . � i
, PROPERTY TAX BENEFITS
` �.., Stafe Fwm 43708 (R9 / 9-OB)
PresaibeE by ihe Depertme�H of Local Go�emmem Finance
File Mark
Infortnatiom m�tained in t�is tlocumenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.1-35-9. N O v ���oOn
J
INSTRUCTIONS:
To be filetl in persm or by mail wifh the CountyAudita o/ Ne county where the properry is loca[etl. �
Filing Datas: 1) Real PropeAy: Ounnq fAe tweNe (72J mp�ths be(ae December 3f o7fhe year fhe deducfion is to be e8 tive.� �
2) Mo6He Homes essessed untler IC 6-7J-7 or manulectured homes rrof assessed es reel propeM��l:NdiY) �R
be/are March 37 0! the year the deduction is to be eflective. '
See reverse side !or adddionallnstnicGOns aiM qualificetions.
Type N berrefi reQUesled (please d�xk a0 Nat appJy)
❑ Over 65 Deduction 6om Assessed Valuation �er 65 Circuit Breaker Credit
Name ot aOdK:�1(o�+�er ar cmi@cl C�yeQ
' �] _ �vv7r�t.,�v
Is epplimM e sale lepal or ea itaWe owneY) If No, what is hisRier ezad share or interesl9
❑ Yes ❑ No
q riame on recoN is diHaram U+an Ihat d epvricant, iMicate 6ebw
Duying m conLacf af loast orre (1) yea7
Pddress d contraC mAer (numDOr end sbae4 ciN, smte, aM ZIP code)
Taxirg diatntl
primarity for
K owned
inditate
spouse,
Is lhB D�ODBRy in Quesiion:
� Real propery ❑ MoDile home (IC 6-7-7-n
Legal description Racortl number � Page number
�19-18-30 �-oDO. 3s 9
Assessed value of ihe pn
,,,_.._. .____..,,,,. Por orer ss deduabn, a
� Yes ❑ No
Nhns the aOd�M 65 yaan of apa or mwa on December 31 of Ihe year
prior b ttie airtant yean
� Yes ❑ No
Adjusted gross ineome of applicant, spouse, and any
indNiduals aharing ownerahip (ForOver 65 deduction, income
may not exceed 525, 000; lor the Over 65 Circuit Bieaker Credit,
income may rrot exceed 530,000 for individuals, or 540,000 fa
married coudes).
Have you fileE lor aM �her deductbns7
Hava you filed for deductions in
�85
�
9
INJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident •
of Indiana and owner of lhe aforementioned property on March 7, 20 %
Sipneture ol ppliczm AdQrass of eD0lipm (number arrd sboel. ciry. sWte, arM Z/P mde)
' k 8 � �. �rin� s� . �� �v�tc� d�- `� � � `�O
� Signaturo bf authonz raprasertlative AEEass of eu�horizad represeniative (nwn0erarM sueet. ciry, stafo, end LP o00)
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