HomeMy WebLinkAboutAge_HutchinsonAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
S '! Sfab Fortn 43708 (R919-OB)
� Prascribed by U�e Departmeirt of Local Govemmem Finance
Intwmetbm m�tained in Nis tloa�menf is CONFIDENTIAL purswnt tu IC E1.1-12-9 and IC 61.1-35-9.
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COUNTY TOWNSHIP ( YEAR j
� File ar
APR 6 2010
�NSrnucnoNS:
To be filed !n person or 6y mail with the CouMyAUdifor o/ the wunty where the property is located �j �
Filing Dates: i) Real P�operty: Dunry the IweNe (12) months belae December 31 0( the year the deduciion is to be ef(e�cGG�.
2) Mobfle Homes assessed unde� IC & 7.7J or manulecturetl homes rrot essessed es real piopertQl$$�J/C��(+�SJ�gnTOR
6e/ore Merrh 37 o/the yearthe deductionls to be eflecWe.
See reverse side /w adddionel lnsWCtions and puefificaUons.
TYDe of benef.t reauested IP�eate dieck e0 Nat appfy) .
� Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Namedepoliranl orconlradDuyeQ
� — �
B ap011fant the lepal or eQUitade owneR If o, what is his,her ezad shara w inie�esl? It ownad with mmeone othar lhan spousa.
inEipte with wtwm
❑ Yes ❑ No
H name on record'u diRerent than Ihst d appfirenl indicete bebw �
Name d contraa seiler (applicanf must nave beon Duyirg m cmt+act at kau orw (f) yearj
Pddresa o7 mntrad setler (rn�mbaraiM sbae4 vly, sbfa. enE ZIP mde) Is lhe p�ooerry in auestion:
�Real pmperty � MoGile home (IC 6-74-n
�.t.,
� Tanirig disirict Key number / Legal OascnDtion RecorE number Page numbar
S- _'-Lb`i- 6: �p
Is the o�Perty used and occuped primariy for 0.ssesse4 value of the prooe'ty as ot Ma`ch 7. artenl year (may rrof arcee0 5182.d?0
hisrtier �asiOerwe7 !or O.er 65 CetluW'm. m 3760.000 for Ne Ovor 65 Circmt Braakef GeQin
�Yes ❑ No
Was the epplicarif 65 yeern ol age or rtrora on December 31 of tha year
Have you NeC for a(ry olher tleductimsl I( Vas, what deductions7
� ,�5 o Na
Have you filed tor Cedunians in any dhar cwnty7 tl 165, what wuMy? �
❑ Yes �No
IIVJe cerlify �ndar penalry of perjury lhal 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 1, 20 _ ''" '
S� eture d eppilcar� nddrasa or evvi�m �nwnew e�d saeeC cey, s e, aiM ZIP�wde)
� J fg`� ?���� °"�" �
ISig �e a�rtnmzea �eo�sem - j� Ereu of euthorimd reweaeniative (nvm0er aM s✓cet, city, s(afo, antl LP cotle)
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