HomeMy WebLinkAboutAge_MichelAPPLICATION FOR SENIOR CITIZEN
` PROPERTY TAX BENEFITS
, � '! Stab Form 63708 (R9 / 9-08)
Presaibed by Ihe DepanmeM of Lacal Go�emmenl Finance
� Infwmation eontainetl in t�is tloamenl is CONFIDENTIAL pursuant to IC 6-1.7-72-9 antl IC 6-1.1-35-9.
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COUNTY I TOWNSHIP �� YEAR j
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A�R"�� 20fl
�NSrRUCnoNS: C � � y
To be filetl in person or by mail wifh the CountyAudilw of the county where fhe property is locafed. V v
Filing Dates: 7) Real Property: Dunng the hveNe (12J monfhs 6efore Decem6er 31 o7the yser the tleduction is to bd33�pti COUNTY AUDITOR
2) Mobile Homes essessed urMer IC 6-7.7-7 or manufacture0 hwnes rrot essessed as reel properry: Dunng Ne hveNe (72J months
be%re Marcfi 37 o/the year tAe deduction is to be effective.
See reverse sitle fa edd'4ionel lns6�dions erxl qualificalions.
lyoe of beneEt �eauested (Wease rheck e0 Nat epp�y�
�Over 65 Ded�clion 6om Assessed Valuation �Over 65 Circuit Breaker Credit
Name of app�raM (orner n cmtrect Euye�
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la eoo�KaM N e legal or ap ' Me owne I( NO, Whal i9 iis/her azeG stura w in�erasi7 tt owned with wmeone d�er Ihan spo�se,
intli�ate wilh whom
es ❑ No
tt name on record'u diRe�eM Nan thal of appfuan� indicate belwi
Name of cort[rea seller (epp/icant musl Aava Oeon bvylig m canUact at least orre (7) yea� '
nddres: w�ono-aa seoer �m.mew aa so-�, r;ry, smte, a�a z�a �> is the o�ooerty in Quastion:
lt'I Real pmperry � Mobile home (IC G74-�
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Taz'ugdisirid Kaynumher/La9aldescription Recordnumber PagenumSer
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Is Ihe o�Pe(1y used and ottu0�ed M����Y br AssesseE value of Ihe proparty as of March 1, curten� year (mey �rot excoed Sf B2,d30
!Jslnar rasiden�7 (or O�er 65 dotl�dion. a 5760.000 !or Ne Over 65 Cticuk &eakar Credi�
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Yes ❑ No
Wiv ihe apd�M 65 yeen of age a more on Decambar 31 o(t�e year
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Have you Ned tor am/ oLhar deOuctions7 �f W s. wnat deductions?
�Yes � No � � . .
Hava you fded for deducGOns in any othar county7 I(14s, what counry?
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INJe certify under penalty ot peryury that the above and foregoing information is We and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ _
Sipnaturaofao0ficam Add�asso(eo0li�nt (numOwendstroo4tiry,sfafe,arMZlPmtla) �
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Si atu of ' ed represer�tative Ad ress of eNhorized rep�eeentative (n�m6er a(H s t, city, sfate, and LP caEe)