HomeMy WebLinkAboutAge_KlusmeierAPPLICATION FOR SENIOR CITIZEN
s± - - PROPERTY TAX BENEFITS
•� .. �! x S�ate Fortn 43708 (R9 / 9-OB)
� ,.i Prescribed by ihe Dapa`imeM of Lacal GovemmeM Finance
Informaliam m�tained in Nis tlowment is CONFIDENTIAL pursuant W IC &1.7-12-9 antl IC G1.1-35-9.
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INSTRUCTIONS:
COUNTY TOWNSHIP YEAR
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To be filed in person or 6y mail wttA fhe CountyAuditor ol the county where the proper(y is located ��!�` J O C O��
Filing Detes: 1J Real Property: During the hvelve (72) months 6efae Decem6er 31 oJ fhe year the tleUuction is to7�'e efleerSzy
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2) Mobile Homes assessed under IC fi1.1-7 or manulactured homes rrof assessed as Fel�9rty: Dunrg t�ie twelve (72) months
See reverse side /ar ad NB'o�� Wdions arM q e/fiwtionsn is fo be elfective. � C�UA/TY A(/ p/TOR
Type W beneft reduested (please Mock aD Ihaf apply)
� Over 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Name of appGCanl (owner or cmtratf Dvye�
Is appfimM lhe sde legal equOaMa owne If No, what is hisTher ezad share or interest'7 If owned with somaona other ihan spoum,
i�Wicate xith whom
❑ Yes ❑ No
tl name on ramrtl is di(farent than that W applrcan� iridicate 6elaw
Name of mM1raU sa0er (app/icanl musf have been buyirg m con4acf al bast orce (1f yea�
Atldress d contrarl mller (numbm and streef, dy, sfab, entl LP wde) �s lhe pmPeery in puestion:
eal property � Mobile home QC 6-74-n
7��g ' Key number/ Legal devsiption RemN numbar Paga number
- � 63 -oo -� �
Is the proparry used a� ompiad piinariy (or Assessed value of ihe p�operry as of March 1, wrten� year (may irof exceed SiB2,130
hisRier msidenea7 forO�er 65 dedudion, or 5760,000 /orNO Over 65 Cucurl &eaker Credin
❑Yes ❑No
Was Ne appGcaM 65 years of aga a mora on Decamber 31 of Lhe year
Have you fJed fw arry Whar deductions? tl 14s, whal tleduUions?
� Yes ❑ No �
Have you filed tu deductions in any other wunry7 If Yes, what counry7
❑ Yes ❑ No
VWe certi(y under penaity of perjury that 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 —7 Lt
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Signature d applicant Adtlress ot appfim^t (number an0 sbaeL �'+ty, sfate, aiW ZIP co0o)
��� � p� � � �1�66�
Signature d aut�orized �eD���a�^'a Address of aNhwimd representaTne (nfen6or ari0 st�ee4 dry, fe, and LP wtle)