HomeMy WebLinkAboutAge_AnslingerAPPLICATION FOR SENIOR CITIZEN
n � PROPERTY TAX BENEFITS
��Stele Fortn 43708 (R918-08) .
� S a� � Prascnbed by tha Departmem of Local Govemmem Finance
Infwmetiom m�tained in Nis doament is CONFIDENTIAL pursuant to IC &1.1-12-9 and IC G7.L35-9.
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INSTRUCTIONS: Q'!6 -^ N i�""a.
To 6e filetl !n persa� or by mail wifh fhe CounryAuditrn o/ fhe aounty wheie fhe property is located. f:RC f1t� c� V
Filirig Dafus: 1) Real Property: Dunrg fhe AveNe (12J months be/ore December 31 0/ the year the deduction is (O�Qe'UT7btWOUNTY AUD�TOR
2) Mobile Homes assessed urMer IC 6-7.1-7 or manu/actured homes not essessed as real property: Dunng the twsAre (f 2) months
6e/we Marrii 37 0/ fhe yea� the tleduction is l0 6e eNective.
See reverse sCe (a add'dional inswdions aM qualificalions.
Type of berreft recuesteO (please d�eck e0 fhaf apply�
I X I Over 65 Deduction 6om Assessed Valuation � Over 65 Circuit Breaker Credit
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Nama d a licarit (w�rrer a conhad Ouye�
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IS dpP��M ��B IBfjBI O! BGIlf12E�B ONIIB%J If No, is Nvher exad share w interest0 H o.med with mmeone oiher than soouse.
inditate wilh whom
❑ Yes ❑ No
H name on recofd is diflarertl than that of epplkant iMicata bebw
Name of coniaG se�er (applicanf musl hava Daon buyirg m cmLacf ef lea9 orre (1) yoarj
Pddress ol mntrad seller (number aM sbeof. ciry, sbin, and Z/P wde) is tha o�oerry in Questior::
� Real pmperty � Mobile home (IC 64-1-�
� Taxing distnq Key number I Lepal descnptian Record number Page number
7 �O '!q - 3/ - 3�3 -000. 009-009
U Ue propeM � aM ompied primaay lor Psseued value of tha pmperty as of March 7, wReM year (may rrof arczeC 5182,d30
his/herrasidenw7 . �o�Uer65dedud�m,ar5160.000forNaOver65CircuilBreekarCrediQ
❑ Yes ❑ No
NFas iha epd��165 yeeta of age or mara on December 31 of the year
S/� /� 7
may not exceed 525, 000; for the Over 65 Circud 8reaker Credit, O �e °`'
income may rrof exceed 530,000 for individuals, or 340,000 for - g
married couples).
TOTAL S 0.00 . �
Have you filad lor arry olher de0ucsons? If Yes, what deductions?
��s ❑Na _S.
Have you fJed far OeEuCions in any other courrty? If 1§s. whal courrty?
� Yes � No
IlWe ceAify under penalty of perjury 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 _
Spnature d aoplicam /ddress of applimr.t (numDar arNstroo4 u:y. s+ata, aM ZIP coda) �
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Signaturaola�'onzed'epreseritative P4Oresaoleulhonzadreprasentative (numberaMS✓eol.ciry.stafo,andLPcode) C�