HomeMy WebLinkAboutAge_Conner� APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR
PROPERTY TAX BENEFITS � � � �
State Form d3708 (R9 / 408)
��•u � P`asaibeE by Me Depart.�nent ot Local Goaemmem Finaxa
Informatiom m�iainetl in this tlowment is CONFIDEN7IAL pursuanf W IC 6-1 J-12-9 and IC G7 J-35�9.
JU�N 1 � 2009
INSTRUCTIONS: /1�/
To be fi/ed !n persm o� by mail with Ure CourrtyAud'Rw o1 the wunty where tlie property is located. �6� N/J��
Filiry Dates: 7) Real Property: Durng fhe tweNe (12) mmfhs 6efae Decem6er 37 0! the year the deduction is to 6e eReCctiv�e,I.r �1C�/�y, q�'�'n
2) Mobile Homes essessed urrder IC 61.7-7 ormanu/actured hwnes rrot assessed as reel property.� (Sd}�r g�B'M1C67VgTi�)Yrri �on�SITOR
6e/ae Ma� 37 0! the yeer Ihe detluction is to be eflective.
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See reverse side !or adddional insLUGions aM qualifications.
Type d hanefJ rapueded (p/aa eck a0 Naf appy)
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name a1 appGcaM (owrier o� canUact Duye�
U apo��an1 the soia tepal or equtlaM a�7 If No, what is hislher eaad share w intarest7 H owned vnlh someone o�har �han spouse.
indi�ate �J�th whom
Yes ❑ No
tt name on record is di((ereM than ihal of aodicant iMiwte bebw
Name ot contact setler (appicant mus! have beon Cvyirg m contract at basf orre (7J yea�
Pddrass W mntratl seller (number arN strae4 �+N, sfata, and ZIP code) Is the o�oDerty in QuesYron:
� Real pmperty � Mobile home QC 6-0J-�
Tming disirid Key numbar / Legal descnption Record number Paga number
o a6- � -, - .s�o-oo
Is Ihe pfope sed and occupieE pnmanly for Assessed value of iha property as of March 7, wrtent year (may nol axceed StH2,a30
his/ner resideno7 !or Orer 65 detluction, m S f 60.000 /or Ne Ovcr 65 C'ucuit &eaArer Credi�
❑ Yes ❑ No
Was lhe applicaM 65 years ot age w rtroie on Decamber 31 01 the year ,4poGfanfs tlate of Gnh (morrth, day, yoar) If filea by a suniving, un:remed sxuse,
prior lo the airtertl yeaR what waz �he spouse's age at lha time
❑ �s ❑ No � .
Inwme Amoum ot Income
individuals sharing ownership (For Over 65 deduction, income $ fl
may noi exceed 525, 000; for tlie Over 65 Circuit Bieaker Credit, Q�
income may not exceed 530, 000 Ior individuals, or $40.000 for g
married couples). _
TOTAL $ 0.00
Have you fileE for arry other deducGOns7 If Yes, what daductions7
� Yes � No
Hava you fileO for daductions in any dher murrty? If �§s, wha� counry?
� Yes � No
I/We certify under penalty of peryury that lhe above and foregoing information is Uue and correct and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March t, 20 _
I SignalureotapplicaM PddrasaofaOP��mrt(numbereMsbaef,ciry,slate,aMZlPwde)
o� l5 o x�a � f N
ignalure f authonzetl re0�entative Addrass of aulhorized representativa (n�mbe�aM sUOef. city, sfate, and LPcotle) ��/ 6 O
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