HomeMy WebLinkAboutAge_Jaquess� APPLICATION FOR SENIOR CITIZEN
_ PROPERTY TAX BENEFITS
Stdte FOrm 43708 (R9 / 9-08)
�,•, � Prewibed by the Dapanmenl of Lorsl Go�emmeM Finance
I�wmatiom m�tained in this dowment is CONFIDENTIAL pursuanl lo �C 6-1 J-12-9 and IC 6�1.1-35-9.
wsrnucnoNS:
COUNTY TOWNSHIP � YEAR
I
I f�(
JUN 1 2009
To 6e filed in person o� by mail with tlre CouMyAutlita o/ fhe county wheie fhe property is /ocated.
Filirg Dafes: 1) Real Pioperty: Dunrg the tweNe (12) mmfhs 6efae Decem6er 37 o/the year fhe deduction is t�flective
2) Mobile Hames assessed uMer IC 61.1-7 or manufectured hanes rrot assessed as real{Zrpp$ NOun e (72) months
be/ae Mardi 31 0l the yeer fhe detluction is to 6e efiective. "�� COUN7Y
AUDITOR
See reverse sde /or a0tlifional instructions errd quelificafions.
Type of banef.t recuesEed �eas W xk e9 Nat apyy)
Over 65 Deduction from Assessed Valuatlon �er 65 Circuit Breaker Credit
Name pplicaM(ownerorcmtracfDuye�
� � Pa..,�
Ia ap011ca�✓�pal or eQUitable ownaR It N what i s/ner exeG ahare w interestl H owned vnth someone other Ihan spousa.
–// indicate w�th whom
Yes ❑ No
K name on (ewrtl is difturem Ihan that d apdican� irMitete bebw
Nama of mrtrz�] seAer (appGwnf must have becn Duying m cmvac! at bast ono (1J yea�
� Pddreas of mntratl seller (nwnbw aM sbaet, cdy, state. aM ZIP mEe) Is ine D�PeM �^ auestbn:
� Real D�operty ❑ Mobila home (IC 6-1-7-�
W� disincf Key number I Legel Eeunption RecorC num6er Page numbar
t� ae-�a-��- �oi-oo�. 3yb- oa s
Is Ma p�opeM �' and occupad pnmaay (or Assessed vaWa of che properry as of March 7, wrrem yaar (may not erceed 5182.430
his�her residencs7 !oi Owr 65 tlotlueim, n 5160.000 !or Ne Over 65 Circuif &eaker Gedi�
Yes ❑ No
Was the eppfimrtl65 years of ege or rtwra on December 37 M Ne year
Hava you filetl for a�ry olhar deductiona7 It Yes, what deduclions7
� Yes ❑ No
Mave you fJed iw deductions In any othar counry? �t rea, what counry?
� Yes ❑ No
IlVJe certify under penalty of perjury that the above and toregoing information is trve and cortect and that the applicant was a resident
�of Indiana and owne� of the aforementioned property on March 1, 20 _.
Signature d appikarrt A40�asa of aoPlimnt (nwnbeieM sboot. ci,y, state, aiH ZIP wde)
S natu�e d authorized represerrtative ACdreas of aW�or'rzad rewasentative (num0era� s✓ee4 ��b: �ate, antl LP cotle)