HomeMy WebLinkAboutAge_RiddleAPPLICATION FOR SENIOR CITIZEN
, PROPERTY TAX BENEFITS
� `` �.. -'• SbmFwm437081R9l9-OB)
Prawi6ed by Na DaDaRmem of Local Govemmem Financa
Information contalneG in this tlocument is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.Y35-9.
bGNTy OWN HIP YEAR
� s � �
t ^ rk
WSTRUCTIONS: �a }'a�
To be filetl in persm or by mail with the CountyAuditor o! the munry where Ute properry is locafetl.. � o nn� C UR!TY AUDITOR
Filing Detes: 7) Real PrvpeRy: Dutl� the hveNe (72J months be%re December 37 0/ fbe year the tletluc rr3iHSSto'tle eNecfive.
2) Mo6Ne Homes essessed uMer IC 6-7.7-7 or manNaclured hwnes rro! assessed es real property: Durirrg Ne twelve (12) mmths
6e/ore March 37 07 the year fhe deduction is to be eflecWe.
See reverse side fa adddional inSWCtions and qualificafions.
Type of beneF.t repue5 (ploeso dieck a9 Naf apW�
Ovar 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
NameWappl' o wcontrecfDUyeQ O
/�
U aGO��m t a sole leqal or eQUitabe owneR If No, wh is tisf,�er exad snare or ir.tarasl7 I( ovmed wiih someone othe� than spouse,
, iniitatewithwhom
❑ Yes ❑ No
H nama on record is diftarent t�an that of aodicanl indiwte bebw
Name of wntact 5eiler (applice^f musthaw Deon Ouyirg on conl2cf af loasf orro (i) yeaQ
Pddrass of mr.tratl saller (numDMaM sboW. cRy. sfafe, aM ZIP codo) �s toe ��o�erty in cues�ion:
Real pwperty � Mo6ile home (IC 6-7J-�
� 7y��� -� ���y Key num�er I Legal desciptio�: � Record numcar Page r.ember
� �G-/� i9-a�i- a�. G�-do%
Is Ihe Pmparty us � an upied ortmanly br Assessed value of ihe pmparty as of Ma¢h 1, wnent year (may nof erceeC SiB2,d30
hislner residenca !or Ouer 65 tladudion, w 5/60.000 for I�e Ovcr 65 Ci¢uit &eaker Credi�
� Yes ❑ No
Was the aoP�av165 yaars of ege w rtrora on Decamber 31 of the year A�
� Amount ot Income
Individuals sharing ownership (ForOver 65 deducfion, income I S
may not exceed 525,000; /or the Ova� 65 Circuif Bieaker Credit,
income may not exceed 530,000 (or individuals, o� 540,000 for I S
manled couples).
TOTAL I S 0.00
Hava you fJeC fw a�ry other tletluclions7 If Yes. w�a� detluctior.s?
� Yes ❑ No
Have you filed fw Ceductiona in any other wunry7 If Yes, wnat counry?
� Yes ❑ No
INVe certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resident •
of Indiana and owner of the aforementioned property on March 1, 20 _
Synatu of aDDfuanl ACtlress of ao01i`ar.t (numEerantl sWeL ci.y. sta:e, an IP cotle) .
� �� . 3�'S S�- I � ' � - `%7��
'naNredauLhodzed`aD�esenaUVe AEdressofauthorizecreaasentative(numGerandstmet.ci,y,sta:e,anCZI code)