HomeMy WebLinkAboutAge_BoesAPPLICATION FOR SENIOR CITIZEN c Nn TOWNSHIP � YEAR
PROPERTY TAX BENEFITS �
S I.rt,.'• SfaleFOrtn63708(R9/9-08)
sPrescribed by the DepartmaM of Local Govem:nant Finance
Information wntained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9. �E (, � j (�ar�QQ$
INSTRUCTIONS: `-7.�
To be filetl in persm or by mail wNh fhe CountyAUtlitw of fhe counry where Ihe prope .ry is IocafeU. a,/ati+ ���
Filiry Dates: 7J Real Property: Dudng the fweNe (72) mm(hs 6efore December 37 07 fhe yeai the deduction is�����c�Nfiv �La�}��,
2) Mobile Nanes assessed urMer IC 6-7. iJ o� manWactured homes nol assessed as real pmperty: Dunng Ne IweNe ( J-mon
be/we March 37 olfhe year the deduc6on is to 6e e%ctive.
See leverse side for addifional inSLUdions aM quelificetions.
Type W Ceneft revuasleE (pleaso Mack eO Nat appfyj
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of eDP�m (mmor w contract bvyoh
�
Is applimM the sole lepal or apuitabl e. It No, what is �isl.'ier exact share or interast9 �f ownad vnth mmeo^e other ihan spousa,
indiote wit� whom
�Y ❑ No
It neme on recoM is diflarent ihan Na1 W eodirant, indicate beiow
Name oi contad seiler (applirant must /iava Deen euying on conuaa ar loa5 one (t) yva�
Pdarass of mntratl SeDer (number antl sbcel. Uy, sfafo. eM ZIP cotle) �s tne orooerry in ouastion:
�Real property � Mobile home (IC 6-7-1-�
� Taxing distncf Key number / �egal dascnotion Record number Page number
��-ia -o�-/a3-c�.aaa?
Is Ne pmperty used and occuoied pnmany br Pssessed value of Ihe omoahy as of Mamh 1, wrrert yaar (may not exceetl S1B2,d30
hislner rB9iEencel :urOver 65 daducti w 5160.000 (orlho OvCr 65 Ciicuit &eake/ CrtdiQ
❑ Yes ❑ No � �
Was the aoWwan165 years o! age o� mwe or. Decamber 31 of tne year
Mave you (IeC for any other deductions) If :es. wn 1 edu �.s?
� Yes ❑ No
Hava you filec (w daEUCtions In any Wher fnur,ryl If Yes, wnat comty?
� Yes ❑ No
IIVJe certi(y under penalty of perjury that the above and foregoinq information is true and corred and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20
Sgnat of apd�wnt AEdress of aoPlicsr,t (numGe� antl sWe(. ci,y, sfato. and ZIP cotle)
� Signelwe d authadzed reorasemative Addrass of authonzed re�easenta�iva (r.umbor arrtl s:ree;. ciry, state, and LP codo)
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