HomeMy WebLinkAboutAge_Manning� "' APPLICATION FOR SENIOR CITIZEN
a PROPERTY TAX BENEFITS
,. ..
�State For,n d3708 (R9 i 9-OB)
� �u � Prasaibed by the Deoartmant of Local Govemmem Finance
Irdwmation contained in this doament is CONFIDENTIA� pursuAnt to IC 6-1J-1&9 and IC 6-1.135-9.
COUN7Y I TOWNSHIP � YEAR j
File Mar
DEC 1 7 2008
INS7RUCTIONS:
To be filed in person oi by mail with Ne CountyAuditor o1 the counry where the properiy Is locafed.
Filirq Dates: i) Reel Property: Dunrg the tweNe (12) months be/ae December 37 0l fhe ysar t6e tleduction is to be sH�`^ ��
2) Mobile Hanes assessed under IC 61.7J o�manulactuied homes rro( assessed as real propertY��i�f���.(�1 Z���t��R
be(we Mardr 31 of the }rear the deduction is to be eHec6�ve.
See reverse sitle for edddional insfructions erid qualificafions.
Tyoe of beneft raQUesied casa tlieck aH fhat app�
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
�Nam ap0licarit( erorcmt2cfD�yoQ�
��� `,� �-�
Is aoolirartl tha soie Iegal or epuitable ov.�neR If No, whzi is nisRier eaact share or interesl If owneC witn wmeor.e other Ihan s�ouse,
indifate HiLh w5ort:
� Yes ❑ No
H name on retoN is difterent Ihan that ot aod���L ��dicate bebw
Nama ot coMract seller (appficant must haue Deen b�ying on cmfrdct at MaA orro (1J yea�
Address of oontratl seller (numbwantl sheel. tM. state, e�M ZIP mEC) �s tne pmoerry in cuestion:
Real property � Mobile home (IC 6-74-�
� 7y�ing '. tncl K y_��'/��ag_ des��O��O/ ���' RecordnumSer Payer.umber
/ _ , � Ci7 v O
�F'�O�JLJ
Is Uie prooerty used and occupied o�manty for Assessed value of ihe omoeny as ot Ma¢h i, wrtent year (may not erceetl 5192.<30
hislher residence7 Por Ouer 65 tlotluGion. or 5160.000 for l�e Over 65 Cilcui! &eaker Cretli�
❑ Yes ❑ No
Was ihe eppikem 65 years of age w mora on December 31 of ine year
�
Adjusted gross ineome of applitant, spouse, and any � Source of Income � Amount of Income
individuals sharing ownership (ForOver 65 deducfion, income I S _
may nof exceed 525,000; Por fhe Over 65 Circuit Breaker Credif,
income may rrot exceed 530,000 fo� individuals, or 540,000 for I I 5
married couples).
ITOTAL I S —�-- 0.00
Hava you filed lor airy other tleduetions7 If Yes, what deductior,s?
Yes ❑ No �S. �
Mave you file0 for deduciio�s in any other cour.ty? I( :es, wnat wur,ty?
� Yes No
I/VJe certify under penalty of perjury lhat �he above and foregoing information is �rue and correct and lhat the applicant was a resident
of Indiana and owner of the atorementioned property on March 7, 20
Synatura ot aodkam l�drass of ao��imr.t (r.um0erantl saoct, c,ry, stam, antl ZIP mde)
�� 9,� 7 �'I.
� SgnatureWauNOnzadreoresenfaWa ACtlressofaNhorizec:?�:esentative (r.umLmantls:rocLCi,y.sta:qandZlPCOde)
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