HomeMy WebLinkAboutAge_TraskAPPLICATION FOR SENIOR CITIZEN
- . PROPERTY TAX BENEFITS
` - -' State Form a3708 (R9/9-08)
� Prasvibad by d�e Deoartmerrt of Loral Govemmerrt Finance �
Information eonlaineC in Nis tlocument is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC E1.135-9.
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INSTRUCTIONS:
COUNTY TOWNSHIP � YEAR
1
DEC 2 9 2009
To be fi/ed !n person or by mail with the CourrtyAUdftw o/ the county where the propeity is located. `--y,.,
Filing Dates: 1 J Real Property: Dun�g the IweNe (12J manths belore December 31 of Ihe year the deduction is to b�f�i�m1.,ef�
2J Mobile Hanes assessed urMer IC 6-7.1-7 0� manulacfuretl homes rrof assessed es real pr��8�n2go MsNe�2) monfhs
belore March 37 0/ the year the deduction Is to be ellecWe.
� �- UNTY AUDITOR
See ieverse sitle !a atltldlona/ insWdioru and qualifications.
Type of 6eneft reQUasted (please dieck all Nat apply)
�Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name diraM(owrrerorcanlracYOVyeQ � � �
� � .
b aoo��M sda lepal or e' de owneR tl No, what u his�her ezaq shara w iritare97 If owned wiih suneone other Ihan spouse,
iMirate wth wtam
❑ Yes ❑ No �
M name an racord'u difle�ern Nan Ihat d eppfiont ��dicaie bebw
Name ot conired seller (epplcanf musf Azve bem buying m cnntrdct at least orw (i) yearj
PdOreas ot contraa setler (numeerand sbeet, ciy, sWte. end ZIP code) Is ihe v�oerry in Quesfion:
eal property � Mobile home (IC 6-7-7-�
' Tazinp districl Key number I Lepal tlascnDtim Record number Pa9a number
- � � - - . c�oo � 33 -1-oa
b the properry use0 aM xwpe0 phmarily for AssesseG value ot ihe property as of March 1, wrtent year (may iat exmed 5�82,d30
hialher residen�s7 Ior O�cr 65 dedurlion, a� Si60.000 for Ne Ovar 65 C'unnf &eaker Cred�
� Yes ❑ No
NSs Ua e0diam 65 yaan of ege or mwe on December 31 ot lhe year
ot �ncome nmourrt ot �ncome
indivlduals sharing ownership (For Over 65 deductbn, income S
may nof exceed 525, 000; !or the Over 65 Circuit Breaker Credit,
income may rrof exceed 530,000 for individuals, or 540,000 for y
married couples).
TOTAL $ 0.00
Have you filed M e�ry other dad�ctions? If Yes, what deductions?
� Yes � No
Have you fiied M deductions in any other cwMy7 ( It Vas. what counry?
❑ Yes � No
IlWe certify under penalry of perjury that the above and foregoing in(orma[ion is true and correcl and that the applicant was a residenl
of Indiana and owner of the aforeme tioned pr erty on March 1, 20
S' eture of pqicam PGdresa of aoG���i (nvnbarerM straef, ciy, slate, aM ZIP code)
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' Sig tu of e z re0 qm e AdEieae ot eul�oriZed ra0�asen�3�ive (namberantl sfreet, city, stato. en0 LP cotla)
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