HomeMy WebLinkAboutAge_Keith"'"„ APPLICATION FOR SENIOR CITIZEN
�_- . PROPERTYTAXBENEFITS
S�.':, seam Form aa7oa (aS � sob)
Prescnbed by �he Dapartma(n of Local Go�emmeM Financa
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File Mark
Infortnation contained in t�is tlocument is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC Gt.t-35-9. A U� 9� qo,�
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INSTRUCT10N5:
To be fi/eAin person or by mail wrth fhe CountyAUditor o/ fhe munty where the property is locafetl. C���
Filing Dates: 1 J Real Property: Dun� the tweNe (12) maMhs 6e/ore December 31 0/ the ysar the deductlon is to 6e e
2J Mo6ileHwnesassessedurMerIC67.1-7o�manulacturedhomesirotassessed��g�p�$1iN�b����72)monUrs
6efae Mardr 31 0/ the year the deduction is fo be eflac6ve.
See raverse side for adddional insWClions arM qualficffiims
Type W henefit requegeE (ploase atl Naf appl}�
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Namedap (mm wcanhaUbuye
La appfimM the sde legal or equitade owne(! M o, what u his�har asaU share or iMerest? If owned with someone othet Ihan spoum,
iMirate wilh wbm
� Yes ❑ No
If name on recnrd is diHerant Ihan ihat of applifant, iMiceta below
Narne W mntract seAer (a f m�a haw bern 6uying m canfrad at /east orre (1) yearJ
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Pddress d mntraG seller (numb aM sbee4 �l: sfate. arid LP mde) Is ihe ProP�Y in Vuestion:
�.Aeai property ❑ Mobile hame QC &14-�
Ta�ting trip Key numbar / Lapal desuiption Recoid number Page number
Cy�LQn�-Cc�t'.� ol�-f3 -i 9-aa�-000. l ooS
Is ihe pmparty used aiM occupied primany br Assessed value ot tha property as ot Ma(ch 1, a�ren� year (may mt exceetl SSB2,a30
hivher rasidenm? lor O�er 65 deducf:on, or Sf 60,000 hr Ne Owr 65 Cucuil &eaker Credi�
Yes ❑ No
Was tlre appGaM 65 years of ape n nrore on December 31 M the year
Have you fJed for arry Mher tleCuctions? It T§s, what daEuctions?
� YES ��IVO
Have youldad tar deductions in any othar mur�ty? If l§s, what courrty?
� YCS �IVO
IIVJe certify under penalty of perjury that lhe above and foregoing infortnation is true and cortecl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
SignaturedappG�aM Addressafapplu2nt(mmDaraMsboeG �.sfafe,aMZlPCOdo)
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S' auN � � e Pddress of authw'rmd representative (n�anbrs arM sLOOf, city, slate, and LP cade)