HomeMy WebLinkAboutAge_CornAPPLICATION FOR SENIOR CITIZEN
, PROPERTY TAX BENEFITS
�'� Stata Fwm 43708 (R9I9.08)
•� � Prescnbed try the DepaM1merit of Local Govemrnem Fi�ance
Informa�ion oonained in this tlocument is CONFIOENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
COUNT� TOWNSHIP � YEAR j
Fi�Mark I
DEC 2 9 2008
wsrRUCnoNS:
To be filed in person o� by mail wNh tbe CountyAUditor o/ the county where the properry is locafed. `�-rQ� ��
Filirg De�s: 1J Real Property: Dun� tha hvelve (12) months before December 37 o/(he year the detluction is to 6e eHecNrve.`
2) Mobile Nanes assessed untler IC 6-7.1-7 ormanulacfured hwnes rrot assessed as real pioperfy: �l$BQTH 7(y'@Q967R'Y�470R
6e/ae March 37 o/Ne year the deduc6'on is to be elfective.
See reverse side 7a adtldional instrudions end quelifications.
Tyoe d DanBN rapue (d�se Meck au Ihaf appry)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of aDP�M ( a cont2ct Dvyv�
. �
Is ao�liqm the sola lapal or ed �table owne(1 If No, what is hislner exact sha:a or interast? If owned witc wmeone other than spouse,
indipte w�th whom
Yes ❑ No
If name on rec.ord is dlflarent than Ihat of eod�caot indicate beiw�
Nama ot cont2d saller (apWicant marf fww Oeen Duying a; cm✓zcf at least ono (t) yea�
AdEress ot mntrad seller (nwnber aM sbeef, crry, sta:o, and ZIP mdo) , Is iha omoe�ty in auesiion:
�Real propery � Mobila home (IC 6-7-1-�
�—"r
Tazing distnct I Kay number / L al deunOtirn I Racord number Paga rumber
� y��-/5�/� 03-�0.o?,��GG�%
I5 � OeM used and occupie D�manly hr 0.ssessed value of iha om�erty as of March 1, wnent year (mny not exceed 5/82,d30
hisfiar reeNenm? hr Ow� 65 dotluUion, w S 160.000 br tha Ovri 65 Ci¢uit &oakor Credi:)
Yes ❑ No
Was lhe eod��� fi5 years of age o� mwe on Dacember 31 0! toe yea� r
( Amount oi Income
individuals sharing ownership (ForOver 65 deducfion, income I S
may not exceed 525,000; for lhe Ove� 65 Circuit Breaker Credit,
income may rwt exceed 530,000 for individuals, o� 540,000 tor I I S
married couples).
ITOTAL S O�G�D
Have you filed for ar.y other deduUions) If Yes, wcat ceductiors?
� Yes � No
Have you filad fw deEuctions in any other counry7 I( Vas. wnat counry?
� Yes ❑ No
I/We certify under penalty o( perjury thal the above and foregoing informafion is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signaeure af appfiw(n Mdress ot aoolimr! (numbr! and swel, ci.y, sfate, aM ZIP code)
�' C�..o-t.-z_ / � G . �- ��--� � . _ -
Signature d authodzed �aD�esentalive Aticrass of aut�orizec rawase tiva (numbcrand s:mef, ciry, s[ate, and ZlP codo)
' ! ` 7G Go `