HomeMy WebLinkAboutAge_Ryan� APPLICATION FOR SENIOR CITIZEN
� PROPERTY TAX BENEFITS
Spta Fwm 43768 (R919-08)
S ui � Presai6ed by �ha DepartmeM of Local Govertmem Finarxe
Intormatiom m�tained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 anC IC G7.135-9.
Y
COUNTY TOWNSHIP � YEAR
INSTRUCTIONS: � � � ��
To be filed in person or by mail with fhe CountyAuditor o/Ihe county where the property is located. �� q ,LU,u
Filing Dales: 7) Reel Prope�ty: Dunrg fAe fweNe (12) months be7orB December 37 o7fhe year fhe deduction is to���Tfeq�vei
2J MobHe Hwnes assessed urMer IC 6-1.1-7 or manulactured homes not assessed es real property: Dunng fhe M1veNe (72) months
be7de Ma�ci+ 37 0l fhe year the deduction is to be ef/ecfive. `�jy /1�y�,
See reverse sde lor edddional insWUions and pualifications. O�"""�} � �
v .. �Tna
TYOa W ba'refit reauested (Nease al Naf aPPN)
Over 65 Deduction 6om Assessed Valuation
Name of apo��wm (owrnr a✓ contrdcY Ouye�
U aoolimm the sole lepal or epuitade owne? If No, w�at is his�har eaad share
❑�� � No
tt name on `emN ia Ci}%rem than
Name d mH� r(e�p�ant must have Deon buyirg on conVact et ba# olm (71 Y�7
I �
Atldrass W mntrae seAer lnumDef arM sbeat. dN. stafe. aM ZfP wde)
Tazi� dlstnct
occuped primanly br
�
❑ Yes ❑ No
Was the eDWKem 65 yeen of age w more on Decamber 31 of the year
orior �0 �he turtem yea(7
� YCS �O
Adjusted gross Income of applicant, spouse, and any
individuals sharing ownerahip (FOrOver 65 deduction, income
may not exceed 525, 000; for the Over 65 Circuit Breaker Credif,
income may rmt exceed $30, 000 !oi individuals, or 540, 000 !or
martied couples).
fidVB YW (IBd f0f 8(Pf OI�IBf dBdUC�M14i
�s
Hava you fileO iw EeCuctions in any dher cwmy4
�r 65 Circuit Breaker Credit
i Someone oiher Ihan 5poa5e.
W�fOT
e vrooertr � aoesci«,:
�T�al property � Mobile home (IC &14-�
Record number Page numher
Assessed value of the pmperry as of March 7, c
!or O�er 65 dedutlion, or 5760,000 (w Na Ova
It Ves, wfijt deEuctions7 ^
❑ N� �J O il'1.�.�1�(�t�lX
� If Yas, what counry?
� Yes ❑ No
IIWe ceAify under penalty of perjury that the above and foregoing information is tr�e and cortect and that the applicanf was a residenl
of Indiana and owner ot the aforementioned orooertv on March 1. 20 .
� Signatureala,Pdicartl
te0reserrtative
ndd�sa ot aovumm (numAer end sboof. ciry. slafe, aM ZIP codo)
� � l 3 �'- 8 `�.-/L�e. ,dl�
Address of aNhonzed represenialive (numDer aM sbeeq ciry. stafo.