HomeMy WebLinkAboutAge_Conder� APPLICATION FOR SENIOR CITIZEN
;..R: � PROPERTYTAXBENEFITS
Stafa Farm 43708 (R9 / 9-08)
` i.i � Presaibed by iha Department of Local Govemment Fina�xe
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TOWNSHIP I YEAR
Infortnation contained in Nis dowmenl is CONFIDENTIA{. pursuant W IC 6-1.1-12-9 and IC 6-1.1-35-9. ��� �—�{ ar�
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�NSrRUCnoNS: '
To be filetl in person or 6y mail wi(h the GountyAuditor o/ the county where fhe property is locafed. Ur j O� U� u
Filing Dates: 1) Reel Pioperty: Dunng the IweNe (12) months be/ae Decem6er 31 of the ysar the deduction is fo �e eBecMe.
2) Mobile Hemes assessed urrder IC & 1.7-7 or manWactured homes lrot assessetl as real property: Dunrg the tweNe (72) months
6e/ore Mart� 31 0/ fAe year the deduttion is to be eflec6ve. �F'� �
See raverse side lor adddional insLUCtions arid qualificafions. C/_ �_, _,,,�,�„e
benefit reQUested (plees eck all Nat apply)
Over 65 Deduction from Assessed Valuation
Name of apDlitarit (owraraCPnfredWyeQ
1�a.rba.��. �- Con�.�
Is ao0�m t�e sde lepal or eQUitable wmafl N No, wtwt u his�har exa .ai
Q'Yes ❑ No
H name on lawrd is diflaraM than Nat d a0o�nt indiwte 6ebw
Name d mMad eller (epplitanf must have been buying on cmVecf et loasf ono (i) yeah
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PdOress o1 mntrad seller �numDer eM s6eel. tiry. sbfe, aM ZIP code)
Taai�p
Key numbar I Legal descriDtbn
�i I�' I c�n�l (,c..fit-j �a.bf�-3_-
Is Ihe 7toVaM use7 atM ottuded G�marily br
hisrtierfeeiOenca7
Yes ❑ No
Was the epplicam 65 yean ot age w more on Decambar 31 0l the year
pnor to ih0 wrterit yBaR
Yes ❑ No
Adjusted gross income of appliwnt, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not exceed 525.000; for the Over 65 Circuif Breaker Credit,
income may rwt exceed S30,000 lor individuals, or 340,000 for
married couples).
Have yau filetl for any olher deCuctims7
�YBS QNO
Have you filed Iw deduciiona in any aher cwrrty?
�Y05 �NO
Q O�ver 65 Circuit Breaker Credit
H owneC vnth someona Wher than spouse,
indifate wit� wtwm
Is Ihe o�0e�y in Quesiion:
� Real property ❑ Mobile home QC 6-1-1-�
IRecord num6ar Pa9a number
�a_oo.t-_ 3:o--so-
d valua of lhe property az of March 1, wrzenl year (maynot exceed Sf82.a30
65 deduGion, ar S f 60.000 /or Ne Ovar 65 Cficuil &eaker Credi�
�fs da�
, rn I$ Q Q K1T
If Yas. what dedudions7
If T4s. what counry?
F9
TOTAL I S 0.00
IlVJe certify under penalty of perjury lhat the above and foregoing infortnation is Irue and conect and lhat the applicanf was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Sipnature of applkanf AEErass of applimr.l (numbcr arrd sbeof, ciry, sWro, a�M ZIP code)
Signature
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aM sboot. Nry, s+atc. antl ZI? :ode)