HomeMy WebLinkAboutAge_Hill" APPLICATION FOR SENIOR CITIZEN COUNTY 70WNSHIP � YEAR
> . . , � PROPERTY TAX BENEFITS
� State Fortn 43�08 (R9 / 9�08)
� ia � Prescnbed by iha Dapatlmenl ol local Govamment Finanw y-
ile;jllark .
Infortnation eontainetl in this tlocument is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.7-35-9. �� �
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INSTRUCT10N5:
To be filetl in persm or by meil with !he CounfyAudita o/fAe county where fhe pioperty is locatetl. DE �� 1 2��8 .
Filing Detes: iJ Real Property: Dunng the tweNe (12J months 6elora December 31 olthe year /he deduction is fo be e//ectrtre.
2) Mobile Hwnes essessed under IC 6-7J-7 0� manu/actured homes not assessed as real pmperty: Dunng fh��(721fn� ths
r� �belore Marrh 31 0/ the year the �etluctlon is (0 6e eNeclive. GIBSON (,`0
Seereverseside%redtlXionalinslrudionsendquelificafions. �N7Y A�JDIT�R
Type o1 banefit reQUesiad (ploaso rhack atl lhef appy)
Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Name d ep ' /�'� a' cartracl Ev}o�
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b aD7��M t�a sde lagal or aQuilaWe ownel7 II No, whzt is �isRiar eaacl share w inleresl9 If owr.ed vnth somaor.a other Ihan soovse.
indita�e wilh whom
Yes ❑ No
11 neme w racord is diflarent Nan ihal of aod�wnt indiwte bebw
Name o/ arrtad saller (app'icanf musf haro Dcen Guyirg on cm✓act al Masf orro (i) yea�
Mdreaa d wntratl sePar (numOw aid sbcot, ciry, slalo, and ZIPcoEe) � Is ihe �moerty in aues�ion:
Real pmpery � Mo�iie home (IC 6-74-n
Taal tl triU - I�y numher I Lagal��� �//�� Racord number Page number
� /a /�-
Lq e prope�ty used and occupied o��w�y �r /�ssessed value of the oropeny as ol March t, curtent year (may no� e+cectl Siffi,d30
hiyher raeidenw7 lor Owr 65 doduurm, a Sv60,000/or No Ovcr 65 Cilcui� &oaker Credi�
Yes ❑ No
Was the app6ceM 65 yean of age or mwe on Decambar 31 of tha year AopGCanfs dale of bi.4 (mm:h, day. ywr) If flad by a survivir.g, unmamad spouse,
prior to Na artem yea�l vAhal was the spoase's aSe at the lime
� ofaeatn?
� Yes ❑ No
Adjusted gross income of applicant, spouse, and any � ' Source of Income Amount ot Income
individuals sharing ownership (ForOver 65 deduction, income I 5 I
may not exceed 525,000; /or the Over 65 Cirtuif 62aker Credit,
income may nof exceed 530,000 (o� individuals, or 540,000 for I S
married couples).
TOTAL S O 0.00
Have you filed Por any olher dedvctions7 If �ps. what r'eductior.s7 '
Yes � No �� ���
Have you (Jed for CeCUClions in any dhar counry7 I i� 14s. what cour.ry?
� Yes ❑ No
IIWe certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20
Signature af appGCant . Atldrass of ap0lifant (num0erantl sheet, ci;�. stale. antl ZIP cotle)
�,l�D?�a �- f ���
Sgnature Uautiodzed raoresen aliva Address of authorized rao�esentative (namCCran s;reel, ciry, s(aM. and ZIP code)