HomeMy WebLinkAboutAge_ArburnAPPLICATION FOR SENIOR CITIZEN
.,.--. + PROPERTY TAX BENEFITS
� -! State Fartn d370B (� I 9-OB)
: uu PrewibaC Cy the Departmerit ot Local Go�emmeM Fina(rcs
�
Irrfomiatiom m�tained in this doament is CONFIDENTIAL pursuani to IC 6-1.1-12-9 and IC 61.1-359.
�
��
WSTRUCTIONS:
COUNTY TOWNSMIP YEAR
� IL,F�`�
To 6e filetl in person or by mail with the CountyAUtlitor o7 fhe munfy where fhe property is located. �AAAY(�
Filirg Dates: fJ Reel Property: Dunng the tweNe (72) mmths belae Decem6er 37 of (he yearfhe tleduclion is fo Otl�6NBC1l�s. 2��2
2J Mobile Homes ascessed under IC bf.7-7 ormanu/acturetl homes ra( assessed as real property: Dun fhe Ne (72J rtwrrths
be/ore Marrh 37 o/Ihe year the deduction is fo be etlecWe. C��n�y�
See revera� side fw additional instrv<Yions and qualifiwtions.
r
Type d 6eneEt repuasted (please Meck aH Nal apply)
�Over 65 Deduclion from Assessed Valuation � Over 65 Circuit Breaker Credit
Name of appfirar�t (owr�ar or cm1+aG Du}vQ I
�V�
Is app6mM lhe sde al or epuitaWe /1 H No, whal is his/her exact share a interast7 If owned vriN mmeme oiher ihan spouse,
indi�etete vn�h whom
Yes ❑ No
K�me on ramrtl is diflare than that W applinnt indicate bebw
Name of m_ilra^r] se0 r(appNcanf musf have bonn buying m canllacf al /easf orre (1f yeaQ
' L
Addmss of mntratl Iler (numbei arM straof, city, sfale, aM LP codo) Is lhe p(opefty in quesiion:
� 1 p ���� eal property � Mobile home QC 674-�
L/ ��_f '�..LCJ ��.L
Tazing districl Key num6er / Legal descnp�ion Record number Paga number
���i'�11�Q a�- ��F- r 8- �oa-000 . s_oo '7
Is Ne pmperry useE anE occupied primarily r Assessed value ot ihe poperry as of Mart�h 1, wrteM year (may rrot exceetl SiB2,430
his�her resiCenw? (or O�er 65 detluc4m, or Sf 60,000 tor Ne Ove� 65 Cucut &eaker Cmdi�
❑Yes ❑No
Was tha appGcaM 65 years ot aga or mne on Decamber 37 of 1he year
Have yw (ded for afry Wher deEUCtions7 n wnai eaa�,mons?
Yes ❑ No
Hava you fded (u daducfions in any aher counry7 It 1§s. what mumy?
❑ Yes � No
IlWe cerlify under penalty of perjury that the above and foregoing information is We and correct and that ihe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ -
$jgr�luredapp�iranc ACd ofapplirant (nun6erarNsboe4dry.sble.andZlPwde)
�� �3l.'i � �cY�
Signature d auUi ad raprasentaliva Pddrass of aNhwim p�mntative (nvnbrlaM sfreet dty, sta:e, andLP )