HomeMy WebLinkAboutAge_StilwellAPPLICATION FOR SENIOR CITIZEN
• :�+. .?= PROPERTY TAX BENEFiTS
Smte Fortn 43708 (R9l 9-0B)
, i�,. � Prascnbed by Ne Departmenl ol Loral Govemmenl Financa
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IMOrtnation tontained in this doament is CONFIDENTIAL pursuant to IC 6-1.L12-9 and IC 6-1.135-9.
�� , N YEAR j
g'd
I � I
DEC 2 6��p��k
INSTRUC710NS: �a� � �
To 6e filed in persm w by mail with fhe CountyAUdrta o7 the aounty where Ihe property is located.
Fililg Dates: i) Real PropeRy: Dunng Ihe tweNe (72) months 6e/ae December 37 o/the year the ded6'ai�i51 Ai 4EOUAbTn1E.A(1DIT�p
2J Mo6ile Hanes assessed urMer IC 6-7.7-7 or manNectured homes rrol assessed as real property: Ounng Nie tweNe (12) months
be%re Marci� 37 o/the year the deduction is to be eHective.
See reverse side 1a atlddional insUVGions arM qualifications.
Type of bBnefi� fepuested (p/ease rheck e0 Nal applyj
�Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of eOM�m (�+� a' cart2U Dvyer)
��/�C) � � `�/ lN/�� C`. J"f4wl �
Is aooliram the mle lapal or aquiteWa ownaR If No, what is hisfner exact snare or interast7 If ownad with someone olher Ihan sPOUSe,
inditata with whom
Yes ❑ No
If name on record is dilFerent than that ol ao�cant indicata bebw '
Name ol con12G sallar (appGwnt must haw boon Ouying m cmLZCt at ba9 orro (1) yearj
Pddress at contratl aeller (numbw arW sboot. cky, sWte, and ZlP wtla) Is ihe o�oerty in Question:
Real pmperty � Mobile home (IC 64-7-�
T�inB distnct Key num6er I Lagal descnotiw Record num6er Page number
�4.�„-.�f L� 2L -I'!_/P-2ol -DD/. D�S-D o7
IS ihe WopeM u9Bd ana occupiBE primanly br Assessed vaiue ot ihe oro�erty as ol March t, curter.t year (may nof excaed 51ffi.a30
hislnar residancai for O�cr 65 doducfion, o� 5760.000 /or Mc Ovcr 65 Ci¢uit Bmaker Crodi!)
� Yes ❑ No
Was the aoO�weM 65 yaars of aga w mwa on December 31 ot tna year
Hava you (dad fw am/ other tleductions? It Vas. wnai aeducocr.s?
� Yes � No
Have you filed fa deductions in any other county7 If Yes, wnat county?
� Yes .� No
1!N/e certify under penalty of perjury thal the above and foregoing information is true and correct and that the applicanl was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature ol epplicant Pddress ol ao�licart (numCer and stroet, cf,y, slate. arM ZIP cnae)
, � � . �/� �ZZ n�. ��lk , o��L�,d �,�F7 � � � �66 �
Signatura of authodzed rapresen alive �" Adtlrass of authwizeC reoresentativa (numbe�and s:ioet. ciry. state, ar.d ZIP codo)