HomeMy WebLinkAboutAge_Nelson,, " APPLICATION POR SENIOR CITIZEN
_ , PROPERTY TAX BENEFITS
Sbte Form 43708 (R9 / 40B)
�� e� Presttibe0 by the Departmem of local Govemmam Finaxe �
Infwmation oontainetl in this Eocument is CONFIDENTIAL Wrsuant to IC 6-1.1-12-9 and IC G1.135-9.
COUNTY I TOWNSHIP I YEAR
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INSTRUC770NS:
To be filed fn person orby mail wifh Ure CourrtyAuditw oithe munty where the property is located. �� n O 2009
Ftiiry Dates: 7) Real Property: During the fweNa (12) mmthi be/ore December 31 of fhe ysar the deducfion is to be tiv��
2) Mo6ile Hanes assessed under IC G7.1-7 or manulaGured homes rwt essessed as real property: Dunrg fhe tweNe (72J months
be7ore March 37 0/ Ne yeer the deduction is to be eflecfive. �'/f� ��
See reverse side lor edddionel inSLudions eM quelifications. f �
T R
Type d beneN repuasiad (p c�eck e0 fhef appy�
Over 65 Deduciion hom Assessed ValuaEon Wer 65 Circuii Breaker Credit
Name of aDP���i (owne/ac Ved DuyoQ I� /�
) o� � on
la epplimm lhe soia lepal or aQUitaMe owneR If No, whal is hisRier eeact ehare w intarast? H owned with semeone o�her than spwse.
indimte wilh whom
❑ Yes ❑ No
M name on record'u dilfereM than thal d eppfran� iMicate babw
Name
nmress w �onaaa
ua�u�:n �
4s Ne WopeM used end occuped
hia�her rasidenw?
mu5f Aave Daon Duying on cvCrdU at bas! orre (7) yea�
eM atroef. uy, abfe, arW ZIP wde)
Is ine
�Real pmperty � MoDile home QC 644-7J
Key number / Legal tlascnpiion Recortf numDer Page m:mber
a�-� � ,�-�fo3-�o.761-��
br AssasseE value of the property as at Mamh 1, wrteni year (mayirof exceetl5782,a30
Ior Owr 65 tlodurlion, a- 5760.000 for Ne Ova 65 Cticuif &oaker CrediQ
Yes ❑ No
Waa �he appGCarM1 65 yean of eBe or more on December 31 W Ne year
prior lo Ne artaN yeal7
Yes ❑ No
Adjusted gross inwme of appliwn4 $Pouse, and any
individuals sharing ownershlp (ForOver 65 deduciion, income
may not exceed 525,000; /or the Over 65 Circuif Breaker Credif,
income may not exceed $30.000 for indivrduals, or 540.000 (or
married couples).
you Ned (or a�ry ather deducCOna7
HavB you filed (or daductions in any
� Y85 Q NO
❑ Yes No
IIVJe certify under penalty of peryury that ihe above and foregoing information is We and correct and that the applicant was a resident
ot Indiana and owner ot the aforementioned property on March 1, 20 _
Sipneture ot apdicartl Address of aD0limnt (numDOrantl stroe(. ciry, sWte, and Z/PCOdo)
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S'ipnatura d arized re0�esemativa Pddress ot aui rizad rewesentatne (nom6er antl sbcat. city. sfato, and
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