HomeMy WebLinkAboutAge_PohlAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
`... � StaOe Fortn 43708 (R9 / 9-0B)
� Prascribed by the Depa�ment of Local Govemmerit Fina�rce
Infwmatian wntained in this dowmenl is CONFIDENTIAL pursuant to IC E1.1-12-9 and IC Gt.�-3S9.
COUNTY TOWNSHIP � YEAR
1
File Mark
JUN 4 2009
�NSrnucnoNS:
To be filed in person or by mail with the CouMyAUditw o/ fhe county where the property_is located. �
Fiii�q Dates: i) Reel PiopeRy: Dunrg fhe tweNe (72) monNs 6efae Decem6er 31 of the ysar the tleduction is fo be e ect�"�
2) Mo6Ne Homes assessed under IC 6-1.7-7 ormenufectured homes rrot assessed as real pmper�irlBQQ�yltl��i ��R
6afae March 37 o/Ne year the deduction is to be eflective.
See ieverse side la edddional inStrvUions eM qualificafions.
TypB of OBnef.t re0uabtad (please rhecit a0 Nal eppyj
�Ovar 65 Deduction hom Assessed Valuation �Over 65 Circuit Breakar Credit
Name apWicaM(owrre/acmbacfEUye�f �
Q . ef- Q�J Q • ��
la eDG ��ha sde lepal or apuitable ownen If No, w�at Ls hia/Aar exarl share or iMeresl? tl ovmed with someone W�er than soouse,
i�Wiate with whom
❑ Yes ❑ No
X name on record is d'ifleiem ihan ihat d appGcen� iMicate beb«
Name d conirad seller (appGtanf musf have baen Duying on canLad et basf ono (7) yea�
Atltlresa of mntraC seller (numDOr and sbee4 ciy. sbro, aM ZIPwOe) Is the` D�o/eM in Questian:
X Y Real property � Mobile home (!C 644-n
�'__'.
� Ty�upEistnd l�/��/� Keynum6er/LepaldescnDtion Recordnum0er Pagenumber
��• a6-�9-r9-�o3-0�/ a�a-oa�
U ihe pmpeM used end acwpieO primariy lor Assassed vaNe oi Lhe wooarry as ot March 1, curtem yaar (may rrof erceed 5:82.a3o
Ids�her resideno) lorO�ei 65 detlurliar, ar E160.O00 /o� Ne Wer 65 CircuA &eaker Gedi�
o Ye5 ❑ No
Waa Ne aDWKaM 65 yaers of age or mae on December 1 of Na year
Fleve you filed fw airy othar EaCuctiws'! If Yas, vrnat deduaions7
�%s ❑ No �_ � .
Have you fileO M daducCOns in any other courtty? If 1§s. what munry?
❑ Yes ❑ No
UWe certiry under penalty of peryury that the above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20 _ � i�
' naWra d appfwaM Mdeaaa of aDO�i<ar.t (number arM sbool. ciry, stata, aM Z/Pwdo)
� c�, � 1 SxE ��rr So o -�29N�f/ N`fl�
Sgn ura of authonzed re0�asaMa6ve Mdress of aNhonzed representative (nam0er arM sLOOq city. stafo, and ZIP caAO)