HomeMy WebLinkAboutAge_McEllhineye
�
APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR i
PROPERTY TAX BENEFITS
� •` , ` State Form 43708 (R9l 9-OB) .
Paufibad by ihe DeDaM1mem of Local Govemmam FL�ance
Fi ark
IMormation containad in this tlocvment is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 67.735-9.
�NSrRUCnoNS: DEC 1 7 2008
To be �led in person or by mail wifh the CountyAUtlitor ol the county wheia the pronerty is located
Filirg Dates: 7J Real Property: Dunng the fweNe (12) morrths belare December 37 07 fhe year the deUucfion is to be eHectrtre.
2J Mobile Hwnes essessed under IC 6-7.7-7 or manulacfure0 homes not assessed as real pioperty:�Ag.�e�Mi�72) months
befwe March 31 07 the year fhe tleduch�on is to be eHective. �
See reverse siee /w edddional inswdions erM qualificaGOns. G�gSON COUA�TY AUDITOR
Type d beneN reGUesied (Weaso Meck a➢ fhat appy)
�Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Ihan ihal of aod�wnt intliwte below
Name W mrrtad se0e� (appficant must haw Oeen ouying m con✓ac: a: Mast oiro (f) yca�
Pdd:ess of contratl seller (numbw arM sficef. crry. s(a:o, aM ZIP code)
� T�ing distncl
�
�
OCCUpiBtl O�IT2fily fOf
orooerty
spouse,
IReal pmpery � �dobile home QC 64-7-n
./���i�tion,G/ �/ � � rE number . Page numDer
« -oa�
IAssessed valua of the 0� rt'y as of March 1, cunent year (may not ercoeC 5182.a30
hr O�er 65 dcduaion, w 5f 60.000/or the Over 65 C"ucurt &eaker C2din
� Yes ❑ No
Naz lhe aOW��m 65 years ot age or more on Oecamber 31 ot tha year
pnorlo the auranl yeaR
�Yes ' ❑ No
Adjusted gross ineome of applicant, spouse, and any
individuals sharing ownership (FOr Ove� 65 deduction, income
may nof exceed $25, 000; for tAe Over 65 Circuif 62aker Credit,
income may nof exceed 530,000 (orindividuals, orS40,000 for
married couples).
Have you (dad fw a�ry other deduUions7
❑ Yes
Have you filetl fp deEUCtions in any other counry7
❑ Yes
� No
� No
If Ves. what aeducCOr.s? �
If ffis, wna� tounty?
INVe certify under penalry 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 aforementioned property on March 1, 20 '
pnatura W aodkem AdEress of aoo���rd (num0er and sueet. c�y. sfate. antl ZIP codo)
l�� ��A�� ���T�c(��`f\
ACdress o/ authwizec raoresanWlive (numDCr antl 5:rect, ciry, sfate. and