HomeMy WebLinkAboutAge_AkersAPPLICATION FOR SENIOR CITIZEN
�rs.-.n. PROPERTYTAXBENEFITS
S ,.' /• Sq1e Fortn <3708 (R919-0e)
Peewibec by the �eoanmenf of Local Govemmant Fir.anca
Information oontained in lhis document is CONFIDENTIAL pursuant to IC 6-1.7-72-9 antl IC 6�1.1-35-9.
� COUNTY TOWNSHIP � YEAR j
�
�.
File ark
DEC 1 `l 2008
�NSraucnoNS:
To 6e filed in person or by mail with fhe CountyAUditw o7 fhe �unty where fAe properfy is located. �j1
Filirg Dates: 1) Reel P�operty: Dunircj fhe tweNe (12) marfhs be/we Decem6er 37 0/ fhe year the deduction is fo b6 e7���
2J Mobde Nanes assessed under IC 6-7.7-7 or manulactured hwnes rrot assessed es real pr��'�ri�i ,t�/v���.�1hs
be/ore Ma�ch 37 o(the year the deduc6on is fo be eHective.
See reverse side fa atld�ional inshudions erM qualifications.
Type W baneft reQUeSed (ploes rliack a0 Nat appfy)
Over 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
Name W aDOGraM (owirer or conbacl Duye
Is aoolimrtl the so!e lepal or eauitabla ovmen It No, what is his/ner exact share or i:.terest7 If owned with wmeone other ihan soouse,
ir.dicate wi�h w,`.o:n
Q Yes ❑ No
It name on record is diRereni than Ihal of aodkant indiwta beiow
Name ol mniad seller (applicant mu5f haw Eoan buyiig on canf�-dct af loast orro (i) yca�
� Pddress W wrtraa seller (numOw a� s5eet, cM• state, arM Z/P wde) �s Ihe o�oeRy in cuesiion:
� Real property � Mobile home (IC 6-7-7-�
�ng distnct Key num�er I Legal descnption I Record number Paga nurr�xr
- - 3�C�03. `l �l3-C� 8
Is Uie wooeM used aM oauped pnmady br Assessed valua of tSe o�Peny as of Ma¢h t, curtem year (may not exceed 51B2.a30
hisRier rasiderca7 (or O�er 65 Gaduccim, w 5160.000 for Mo Over 65 Ctic�if 6maker Credi:)
❑ Yes ❑ No
Was tha eoWKan165 years ot a8e or mora on December 31 of tha year
Hava you filed for eny Wher daEucGws9 It Yes. what aeductior,s7
� Yes ❑ No
Have }rou flad tw deductions in any Wner counry? �f :'?s. wnal courxy?
� Yes � No
I/VJe certity under penalty of perjury lhat the above and foregoing information is true and correct and that the appliwnt was a resident
of Indiana and owner of the aforemantioned property on March t, 20 _
� Synature W aoyieanf AECress ot aoolipnt (numflerantl suceC c�ry. stale. aiW ZIP rode)
Sign � of authonzed :eoresantatrva d ess of autnorizec :exesentative (num0cr antl s:met. ciry. -. and ZIP code)
� '�//y Cl/. .�,� �7G7o