HomeMy WebLinkAboutAge_TaylorAPPLICATION FOR SENIOR CITI2EN
rt. � PROPERTY TAX BENEFITS
S -'' State Fortn 43708 (R9 / 94B)
� Prescribed Gy the Oapartmerit of Local Govemmertl Finance
Infwmatian tontaineE in Nis dowment is CONFIDENTIAL pursuanl ro IC 6-1.1-12-9 and IC 61.1-35-9.
�
�
fNSTRUCTIONS:
COUNTY TOWNSMIP YEAR
iie M
To be filetl in person or 6y mail wifh (he CounryAudita o/ Ne counry where fhe property is locafetl. ~ r R � U� O, O
Filing Dates: 7) Real Property: Dunrg Ihe fweNe (12J marths befo�e Decem6er 31 0l the ysar the deducfion is to be eRective.
2) Mobile Hanes assessed urnier IC �7. 7-7 or manufectured homes rrot assessed as �eal pmperty.� Dun N�j�qw+fhs
be/ore March 37 o7fhe yeer the deductlon is fo 6e eNec6ve. V�
See ieverse side �aeddaiona�inswctions alMQua�ifications. 81B8�N �@ NfY QUDITOR
TYDB o( beneEt �eGUeEiBE (plee5e Motk a➢ Nat aPWY)
Over 65 Deduction 6om Assessed Valuation � Ovar 65 Circuit Breaker Credil
Name of a0��ri (owrier or caRlacf Cuye�
02
Is apDlicam the sda leg o eQUitable ame(1 0, what is his/nar exact s`are w inte�est? ff owned wilh snneone dher Ihan spouse.
indinte with whom
❑ Yes ❑ No
tl name on rerord is diflareM Man iha� o( eDV���t indicete below
Name of m'rtad seller (epp(zant must hare Ooen buyiip an contlaa at least orre (1J yaaQ
AdC�ess W contrad sa0er (mmber and street city, steb, antl ZIP mtla) Is tna o�oeM �� auestion:
�Real property ❑ Mobile home (IC 614-�
Taxing disind Key number / legal descflption Record numDer Paga numher
i�2,���- /9- �o� ���. �G- Qa ,
Is Ihe D�oGeM used anE occupied pnmadly br AssesseE value ot the o�0erty as of March 1, cunant year (mey not exceed 51H2.d30
hiNhar resideno7 1or Owr 65 Eotlurlion, or Sf60.000 )or Ma Ovnr 65 Ciicuif Braaker Credi�
� Yes ❑ No
Was the applicem 65 years o(a8e or more on Decembar 31 of tha year
Have you fled for em/ olher deducGOns7 �t ws, wna� dedu�ao�s?
� Yes � No
Nava you fded tw CeEUCCOns in any other countyi I It Vas. whal caumy?
❑ Yes ❑ No
I/VJe certify under penalty of perjury that the above and foregoing in(ormalion is true and correct and that the applicanl was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signatura W eod�canl Addrass of o��imnl (numGwanC of, city fafa, ard ZIP cnde)
�/
, � 03� �'�o�
Signatura onzad �eo�esenta' Address of eufhwizad reoresenWtiva (namboran0 s✓eet, ciry, sfafo, and ZIP co0a)