HomeMy WebLinkAboutAge_AnthonyAPPLICATION FOR SENIOR CITIZEN
, PROPERTY TAX BENEFITS
, Sfale Form 43708 (R9/4-08)
�� � � P`eauibed 6y tlie �epa�merM1 of locel Go�emmem Finance
IMormetion wntained in Mis Eocvment is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC G7.135-9.
INSTRUCTIONS:
To be fJedln person or by mail with Ure CountyAudita ol fhe munty where fhe property is locatetl. 'Y O V 1� Z009
Filing Oates: 7J Real Property.� Dunrg fhe hveNe (12) monfhs befae Decem6er 31 0! the ysar the deduction "s to be eNective.
2J Mo6Ne Homes assessed under IC 61.7-7 ormanufectured homes rrot essessetl es real piop unry�jyeAa (72) months
bafore Mart� 37 0/ the year fhe deduction is to 6e eflec6ve. �l�
See reverse sdeloredddional insLUdions and qualiBCalions. C'�BSON COUNTY q DI7pR
Type d berrefi reauasted (please dreck e0 Nat appy)
Over 65 Deduction from Assessed Valuafion Over 65 Circuii Breaker Credit
Name a.0o�m (or,�er «cmhacl DuyeO
la aDD� �ha sde lepel or eQUitable oaneR If No, v.hat u hia/her ezact sture w irtlerest'! tl owned with someone oiher than spouse,
intli Wte wi�h wtrom
❑ Yes ❑
H name on rem(d L+ diflaraM tnan that d apdirant iMicate bebw
Name of conc2cl seller (eppicenf must liaw Dem buyirp m conUact af lea5 one (7) yoa�
AdO�esa o1 wntrad eeVar (numAa aM saoo4 ciy. sbb, arW ZIP wde) �s tna pmoeM in duestion:
�Real pmperty � Mobile homa (IC 6-7-1-�
i—•.
�Tazlrg 'Iricl Keynu 6er/L alEescnDtion numDer Paganumber
� /� D/- 'S�'`�'' �.o?s�aa?o�
U Me Gmperty used aM occuroeC GAmarily lor Assessed value of Ihe prooe(iy as ot Marth 1. wrtert year (may rrot crcccE a 182,a70
his�her resideno? ror Owr 65 tlodurlim, a 5160.000 !or No Ovar 65 Cwicuit Brcaker Cretli�
Yes ❑ No
Was tha appficaM 65 years ot age or mora on December 31 of the year
Hava you filed fw ary othar deEuttims? tf Ves. what deduc}iona7
� Yes � No
Have you filed for Oeducfions in anY othe� wuMy? I( �4s. what county?
� Yes ❑ No
IIVJe certify under penalry of perjury that the above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20
Sipnatura of apOficaM Address ot apDliqM (nrmEer and sbeef, ciry, sbM, antl ZIP code)
��µineture of a• orizetl �eD�ase'rtatrva Mdress of authorizad rawesentativa (num aM�to. and LP catle)
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