HomeMy WebLinkAboutAge_Bethe�"' APPLICATION FOR SENIOR CITIZEN � couNn
:y. - = PROPERTY TAX BENEFITS I
S�am Fwm d3708 (R9 i 9-0e)
�•' �u. � Ptesuibed by the Dapartmert of Local Govemmeni Finance
In`ormation containetl in this doameni is CONFIDENTIAL pursuant to IC 6-1 J-12-9 and IC 6-1.135-9. �
C
TOWNSHIP I YEAR
g F�le M�
�� �INSTRUCTIONS: �Y
To 6e fifed in persm or 6y mail with the CountyAudifor o/the couny where the property is locafed. j��� y
Fili�y Dates: 1) Real Property: Dun�q the twelve (12J months be/ore Decem6er 37 o/the year the tleduction is to be efl4t;li�.6. 3 y 2008
2J Mo6ile Hanes assessed urrder IC 6-1J-7 ormanulactured hwnes not assessed es real pmperty: Dunng the h.eNe (72J monL�s
be(ore March 31 07 Ne year the tleducfion is to be eNecWe. �
See reverse side la edddional instructions end qualifications. P� �
Type d benafit �ecuest (ploaso rheck aB Ihat appy) � �%B�i�1�
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Qedit
Name
sde �epa� or eduitab�e owq4q'/ � If No, what is hislner
Yes I I No
It name on record ia dilterent than
of mrtred selle� (appl'rcanf must have been 6vying an con✓act ef /east orro (1) yoarj
Addf8590( WtlbBd SBOBf (A1lm68ldM5bBBt, CRy.Sfd:¢,
Key numbar / Lagal
� -i9-,
Is Iha propeM used and occupeE pnmanly for
his/ner residBnce4
❑ Yes ❑ No
Was lhe eoolipm fi5 yean of ege or mwa on December 31 o(the year
onor to the arrem yeaY)
❑ Yes ❑ No
Adjusted gross ineome of appliwnt, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not ezceed 525,000; for the Ovar 65 Circuit 82aker Credit.
income may rrof exceed 530,000 for individuals, or 540,000 for
married couples).
Have you flad tw erry olher deductionsT
� Yes
Have you fled tw tleducUOns in any mher cwmy9
� Yes
or
It owned with someone other Ihan socuse.
indinte wiN whom
IS lhe D�ooerty in
I � u Real properry � Mobile home QC 6-74-�
.7i
on I Record number Paga r.umcer
�O/- �� a�-a�9
Assessed value o( lhe o�ooarty as of Ma¢h 1, wrtent year (may not exwetl 5f82.a30
for O�er 65 dedvction, a 5160.000 7or Na O✓or 65 Ciicui( &eaker Cretlit) �
IIWe certify under penalty of perjury that the above and (oregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
7natu�eotappl'ram � � drassotaooli�ni(numEerar.tlstree(,crysate,arNZlPCO�e)
� Lc_. , i/ o iV. , rl�-�,� ��t�,3 �r nT ,
S�gnature o( euCiwrzed �a0�ai ntetive (l Address of euihonzed raa�asantative (num5er artC s✓eef, ciry, 5ate, and ZIP code)
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