HomeMy WebLinkAboutAge_McIntireo APPLICATION FOR SENIOR CITIZEN
� .,. .^ PROPERTY TAX BENEFITS
SCte Fwm d3708 (R9 / 9-08)
S��i � P(eacnbed by ihe Dapartman� of Local GovemmeM Finance
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COUNTY TOWNSHIP � YEAR j
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'`File Marks—�1
Informatiom m�tained in this doament is CONFIDENTIAL pursuanf to IC 6-1.1-12-9 antl IC 6-1.7-35-9.
�NSrRUCnoNS: ��� 1 1 2008
To be filed in person or by mail wdh fhe CountyAUtlita of fhe counry where fhe property is locatetl.
Filing Detes: 1J Reel Property: Dunrn� (he tweNe (72) months 6e/ore Decem6er 37 0/ the year the deduclion is fo be eflec6ve_ �; '�� �,� ��'�,
2) Mobile Hwnes assessetl wMer IC 6-7.1-7 or manWactured homes rrot assessed as real property.' Dunng fhe twehre (72) monfhs �
be/ae March 37 o/fhe yeai the deduc6on is fo 6e eNec(rve. GtoS!iiV COU\�TY AUDITOR
See reverse sltle lw additional i ruGions arM Oualifications.
Type ot beneft raQUested Se Mttk aU thaf apptyj
Over 65 Deduction hom Assessed Valuation ver 65 Circuit Breaker Credit
Nzme of apoliraM (or+m� tr�dct 0uyo� � ^ .
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Is xD0limnt lhe 5We lepal or eQUitable owna If No, what .^.isL�er e�act 9hare or interest? If owned vnth soraona ciher Ihan soouse.
indi W le with wham
❑ Yes ❑ No
If nama on recoM is Ci}faren� than ihat of aodiwnl indicata bebw
Name o1 mnirzd seller (applican� mus haro bcan Euyiig on cm✓act af least arro (1) yearj
P.ddrass d mntratl sallar (numberaM sbeet. city, sWM, nnd ZIP wde) �s tne omoerty in auestion:
� Real property ❑ Mobile home QC 6-74-�
Wingdi ct Keynumber/Legaidescno�ion IRacorCnumSar Pagar.umbar
/t,vl�-l�c. a�-�� �z �o�-a��. g ��.���
Is L:e prooeM used and oaupiad o�rr.any br 0.ssessed value of ine D.rooeny as o/ Ma¢h 1, cur.en year (may not erceetl St82.d30
his/nar resideno7 fo� O�xr 65 dedvCim, a SS60,000lorlhe Over 65 Cir�uit &eaker Crctlit)
Yes ❑ No
YVas the apWicam 65 yeaw ot age w mwa on Oecambar 31 year
Hava yw fiiad for any Mhar detluctions? It Yes. what Geducticr.s?
� Yes � No
Haveyou �led tp tleduciions in any mher counry7 If :es, what cour.ty?
� Yes ❑ No
IIVJe certify under penalty of perjury that lhe above and foregoing information is We and correct and fhat the applicant was a resident
of Indiana and owner o( lhe aforementioned property on March 1, 20
Signalura epplicaM Addresso/aoo�icam (nvmDerandsneet,ci.y,s;aro.andZlPmde)
�. ,17 � . — i N a s .ie(-���soti
Synature o( auNwiz eresentative P.ddress of euihwized rea�esentative (numEerarM s:roet, ciry, stafe, anC LP cade)