HomeMy WebLinkAboutAge_Karcher�" APPLICATION FOR SENIOR CITIZEN '��
,. . PROPERTY TAX BENEFITS ��
�'• State Form 63708 (R9l 9-OB) � /
u Prexnbed try Na Deoanment ol Local GovemmeM Finance
Infwmatiom m�tainetl in this doament is CONFIDENTIAL pursuant to IC 6-1.1-72-9 antl IC 6-7.1-35-9.
COUNTY TOWNSHIP � YEAR j
File Mark
INSTRUCTIONS:
7o be fiied in person oi by mail witfi fhe CountyAUditor o/ fhe munty where fhe propeM �s located.
Filirg Dates: 1) Real PropeRy: Dunng fhe fweNe (12� mmtAs be/ore Decem6er 37 of fhe year fhe deductlon is fo be eNective.
2) Mo6ile Homes assessed uiMer IC 6-7J-7 or manu/actured homes nof assessed as real pmperty: Ounng fiie twaNe (72J mmths
belore March 37 o/Ihe year the deducbon is to be eHective.
See reverse side lw edddional insWdions arni qualifiwtions.
TyoeofbenaNreouesfed(pl MeckaqNatappfyj
Over 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
Name o( Wira�l (owner a caHrdct DuyoQ
�^'/w_
U a�ormM tha sola legal or epudaWe owneR it No, what is nislnar esaa ahare w c�terest? If owned with somaor.e o�her �han spouse,
�/ i�ditate vntn vnom
� Yes ❑ No
tl name on record is diflarem than ihal of aod��t �ndicata below
Name U contact sallar (applicant mu5t haw boon Ouyirg on cm'vacf af least orro (1) yoa�
� Pdtlress of mniratl seller (number aM sboef, cKy, sWto, aM ZIP wde) Is the o�ooerty in Question:
� Real property ❑ Mobile home QC 644-�
'ng distnci Key number / legal desuiption I Record number Page numDer
'- 6- I a-�'] - iol-oo�. � a�-oa�
I5 Ne pmDeM used and occu0ied primanly br Assessed value of �he Oroparty as of March 1, wrtenl year (may nof excaed 5f82,a30
hislnar resitlenm7 (or O�er 65 doduGion, or S 160.000 lor Mo Over 65 Circuit 8roaker Credit)
❑ Yes ❑ No
Waa tha aoWwam 65 years ol age or more an December 31 d tne year
Hava you filed for a.ry dher tieduGbnsl If Yes, w�hat CeEuctions?
� Yes � No
Hava you (dsd tor tleCUCtions in any othar county7 �� �es, wnal munty?
�Yes ❑No
IIVJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March t, 20
� Signature af a0d���� Address of aoolim�num0erantl sncet, ciry, stato. and ZIP wde) �� I
�a w
e �� maw,«;:ea reo sentativa Address of aut�wixed reaesentative (numberand s: iry, state, anC LP code)