HomeMy WebLinkAboutAge_McClellan� APPLICATION FOR SENIOR CITIZEN couNrr � TOWNSNIP � YEAR
� PROPERTY TAX BENEFITS � �
'�'• State Form 43]08 (R9! 9-08)
Prascnhed by Iha Deoartment ot Local Govemmen� Fv:ance
File Mark
Information containetl in this tloament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7-35-9. Q E C `3 j 2008
� INSTRUCTIONS:
To be filetl in persm or by meil wifh the CountyAudifw o/fhe county where the property is loca(ed. �a�. ,�',+('!'���, �
Fili�g Detes: i) Real Property: Dunng the (weNe (72) monfhs be/ore December 37 o/(he year fhe tletlucfion is to 6e eH c(ive. (/
p�gso!� �,�� v e i�, �7 o�ms
2) Mobile Hwnes essessed unOer IC 64. 7-7 or manufacfured homes no( assessed es rea pmperry: DSn7ig tTie tws/v� �%�� m
� belore Marrh 37 of (he yea� the detluclion is fo be effective.
See reverse side la atltlifional inst�vdions and puali6cations.
Type d benef.t repuested (ploaso Ucch a0 Nnt appfy) I
�
I/ name on recoM is difleran� ihan Ihat ol aDd�wnl inEiwle below
Nertre d cont2d seAer (ep�canf must have been buying m cmtrac( at leas! orro (1J yea�
� ldCrasa ot mntrad SeVer (numDeraM sbee4 u:Y. skte. anE ZIP wtlo) � Is the oroperty in Cuestion:
� Real pwperry � Mobile home (IC 644-n
Tazinp disinct ` Kay numba� I lagal Eescnption I Record numbar Page number
(� -/8- o� -/00 -000. 38��- oa �
Is ihe oropeM used and occupied pnmany br 0.ssessed value of the omoehy as ot Maruh :, wr.ent year (may not ercoctl57H2,<30
hiaRier (esiOence7 for O�er 65 tladuGian, w 5160.000 Ior (ho Over 65 Circui! &eaker Cretli�
Yes ❑ No
Was Ne aoM��165 yean of aya or mwe on Decembar 31 of tne year
Have you @aE br any other deduGions7 If Ves. what AeAUClions9 '
�Yes ❑NO /�_ S ,
Have you (JeO fw deduc6ans in any dher cour,ry7 I If Yas, wnal covnry?
� Yes ❑ No
INJe certi(y under penalty of perjury lhat the above and foregoing information is true and corred and that the applicant was a resident
�of Indiana and owner of lhe aforementioned properiy on March 1, 20 .
$igneture d apd��� Address of aD���mr.t (numtcrantl sfrocl. crry, slafc. and ZIP cotic)
,�- %i1c ' � �t, � `�I66.� ��o
Signature d euNorized re0resentalive Adtlress of authorized re�r sen�alive (numOCr antl s:me(, ciry, sfatc, and ZIP codo)