HomeMy WebLinkAboutAge_Green� APPLICATION FOR SENIOR CITIZEN
-R � PROPERTY TAX BENEFITS
� �! State Fwm d3708IR919-0B)
Pfescn6ad 6y the Deoartmem ol Local Govemmem Financa
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Infortnalion wntainetl in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.1-35-9. `'y� v
INSTRUCTIONS: O�IG� �/��
To 6e filed in person or by mail wifh tAe CountyAUditarof the county where the property is locafed. OIBSON COUPITY AL'pITOR
Filirg Dates: 1) Real Property: Dunng the tweNe (12J mrnths 6e/ae December 37 olthe ysar the deduction is !o be eNective.
2J Mobile Homes essessed ��Mer IC 6-7.7-7 ormanNactured hwnes not assessed as real p�operty: Dunng fhe hveNe (72) monMs
be(ore March 37 0/ the year fhe deductlon is to 6e eNactive.
See ieverse stle for adtlitional instivcfions arM qualificafions.
Typa W benefit repuasted (yoese d+eck a0 Nat apply)
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indifate hebw
Name of mnt2G seller (apd��anf m�sf haro Oeon Ouyirg a: conlract at loast ono (i) yea�
� AOdress ot mntratl seliar (num6eraM SbcaC riy, stafa, a�M ZIP code) �s tne omoerry in cuastion:
eal pwperty � Mobile home (IC 64-7-n
Taaing distnci Key num.ber / Lagai deuno�ion Record number Page number
a,.�.�-�-�c �?!v -�3 -1 3- S'da - pDO. 59,3 -o 07
U Iha pmper�y u5ed and accupad pn ly br Assessec value o( the oro0erty as of March 1, wrter.t year (may nof excacd S1B2.<30
�isrtier residenm? hr Over 65 dcdvdion, ar S 760.000 Por tho 0.er 65 Circur. Bicaker Crotlrt)
Yes ❑ No
Was ihe ap�liprit 65 years o( age or mwe on December 31 a( lhe year
Have you fJed tor arry othar deductrons7 If Yes, wnat ced�ciions?
�Yes � No s p� � (
Hava you (Jed fw dBCUClions in any othar wunry7 If s, wnat covnty?
� Yes ❑ No
I/VJe ceRify under penalty of perjury that the above and foregoing information is We and wrrect and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20 _
gnatu Plicant dress of aoolirart (numberand sWel, ciry, slate. arM ZIP mEO)
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Signat re � auNOnzed reoresentative ACtlress of authnizad rewesertativa (numDe�and s:mel, ciry. xaro. and DP code)