HomeMy WebLinkAboutAge_JinesAPPLICATION FOR SENIOR CITIZEN
x. n- 4 PROPERTY TAX BENEFITS
` -' Sfate Fwm 43708 (R9/ 9-0B)
P(aaaibed by Ne DepertmaM of Lacal Govemmem Finance
� Infortnatiom m�tained in l�is Cocument Is CONFIDENTIAL pursuaN to IC 6-1.1-12-9 and IC 6-1.1-35-9.
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COUNN TOWNSHIP � YEAR j
le
APR 3 0 2U10
wsrRUCnoNS:
To be filed ln person or by meil with the CountyAVdita a/ fhe counry where fhe property is loca(ed.
Filing Dales: 1) Real Property: Dunrrg fhe hveNe (f 2) monNS 6efore Decem6er 37 0/ the year the detluction is 6�t'�
2J Mo6ile Hanes essessed u�Mer IC fi7.1-7 or manufacturetl homes rrot assessed as real�(fjp��o�� �t21 Ronfhs
be/ae Ma�dr 37 0/ the yeer Ne tleduction is fo 6e elfective. TO
See reverse sitle la atldaional inswdions arM qualifications.
Type d benef.t rapuested (yeaso Mock a0 fhat applyj
,�Over 65 Deduciion trom Assessed Valuation �er 65 Circuit Breaker Credit
Name d aoW�m (owrre� or cmhect DyoQ
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U a0ofuam Ne sde legal ar eQUitaWa ameR tl No, whal is his/her ezaq sFara w'urterest7 It wmed with spneone ahar than sDOUSa.
indidte with whom
❑ Yes ❑ No
H name on rewrtl is diflererit Man iha� d eDd'us�t ��dicete below
Name d mntrad seller (epplrcant must hare Ooon Duy'up on cmt2d al basf orre (1J yearj
Pdtlress o1 mntrad seller (numGweM abeef, city, sfate, aM ZIP cotle) Is �na p�ooeM �� auestion:
�Real property � Mobile home (IC 6-7-7-�
Taninq disincl � Key number / Legal descnptiw RecoN number Page number
QG!�`�-O� ,2l� -l'f-1 3 - �0.3 -000. 57 -OO 7
Is Ne pmpery used eM occuped pnma br Assessed value of Ihe prooarry as ot March 1, curtem year (may rrof erceeC Si82,d30
hisfier residanm7 /orO�er 65 deduC'an. a 5760.000 !o� Ne Ova 65 Circud &eaker C�edit)
❑ Yes ❑ No
Was �he epplicaM 65 yean of ege w rtrore on December 31 of the year
Have you filed lor erry other deE�a7 If Yes, what deduqions7
�"Fes ❑ No �—i s
Nava you fiied fw deOudans In eny dher counry7 ( If 14s, what coumy? •
� Yes ❑ No
IM/e certify under penalty of perjury that the above and foregoing infortnation is true and wrrect and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signaturaola�wnl Mdressofappli�nt (numbwaMSfroef,ciry,stata,aMZ/PCOtlo)
� � � / � �17G6v
ignature W auNwized rao�ea �ativa Mdress ot authonzed reo�esenta�iva (numEOrand sfinef. ciry, stafn. and Z/P c e)