HomeMy WebLinkAboutAge_AnteyAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
� S �! Sfate Fortn 43708 (R9I40B)
Prescribed by ttia DepartmeM ol Locel Go�emmerit Financa
Infortnation wntained in this dowment is CONFIDENTIAL pursuant to IC 6-1 J-12-9 and IC &1.1-35-9.
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COUNTY � TOWNSHIP � YEAR
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DECF�e Oa�10
INSTRUCTIONS: .
To be fileC in persan or by mail with the CountyAUdRa o1 fhe county where Ihe property is locatetl. ��G� ��
Filirq Datas: 1) Real Property: Dunrg tlre hveNe (72) months be/we Decem6er 37 o7the ysar fhe deducfion is to be eHecfive� ��
� ��p�� �;(��t�Y �UDIT�R
2 Mo6ile Homes assessed urMer /C 6-7.7-7 ormanulactured hwnes not asseued as real pmpe e (7 mon s
be(ae Mardr 37 o/Ne yeer the tleduction is l0 6e eHective.
See �everse sitle lar adddional insWcfions aiM qualifications. � t l � a-�( j. p
Type d barrefit repuestad (please rheck eb Ne( eppy)
�Ovar 65 Deduction from Assessed Valuation er 65 Circuit Breaker Credit
NameofaDO�� (�T�e/o'�a������/Ye/J �
L9 aoD�uaM Ne sde lepal or equitable owneY! tt No. w�at is hi er exed stura w in�erest? tt owned with swneone oiher than s0ouse.
ifMimte with wMm
❑ Yes ❑ No
M name on racoN is difte�eM Man tlut d appfimnl iMicete bebw �
Name ot cont2p saller (apyircanf musf hare Eaon buyirp wn conuact at leasf orre (1) yeaQ
P4tlieaa ol o�ntrad saller (numberaM abeat. crfy, stab, and ZIP mde) �s the O�oe�ty in Question:
� Real properry ❑ MoDile home.(IC 6-74-�
Taxin istnq ` Key number! Legal descnpiian Recard numDer Page numCer
a �-�a -►� - �03 - � °3. 3�s-o�,
Is the propery used aM occuped pAmarily far Assassed value of lhe proparry as of March 1, current year (may rrof excaetl 5:82,a30
hiNhar `esidente7 for O�.er 65 deducfion, a Sf 60.000 (or Ne O�rx 65 C'ucait Broakei Ged�Q
� Yes ❑ No
Was 1he epplifan165 years of age w more on Dacember 31 o(the year
Hava you filed far arry olher deCUCeona? �� Ws, wha� daduclions?
��s ❑ No /�S'�f /v�-f�
Have you fJed for deductions in any other couniy7 If Ves, what coumy?
� Yes ❑ No
IIVJe certify under penalty of pe�ury that the above and (oregoing informalion is true and correct and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
Sipnelureoiapplimm Add�esaofaDD��wm (nwnborendstreef.ciry,slafe,aMZ/Pcode)
.% a O � � � %� �
�5' neture of authorized �aO�seMativ Md�esa of aWtrorixed ra0�esentativa (numberantl s[root, ciry, stafo, nE Z/P coda)