HomeMy WebLinkAboutAge_Morrison (4)APPLICATION FOR SENIOR CITIZEN c row na
��- . PROPERTY TAX BENEFITS
` ! Stafa Fortn 43708 (R9 / 9-08)
� Prexnbed by Na DepartmeM ot Lacal Govemmam Finance N 7 �u �
File Mark
Informatiom m�tained in this davment is CONFIDENTIAL pursuan� to �C 6-1.1-12-9 antl IC 61.1-35-9. n
INSTRUCT10N5: �s+U� N
To 6e filedln person or by mail wHh the CountyAuditw o/ the county where fhe property is locafed. OIBgON COU NTY AUDITOR
Filing Dates: 1J Real Property: Dming fhe tweNe (72J months 6efore Decem6er 31 07 the year the deduction is to be eHective.
2J Mo6ife Homes essessed under IC 64. 7-7 or manufactured homes rrof assessed as real property: Dunng the twelve (72) months
be(ore Mard+ 37 07 the yeer the tleduc&on is fo be eflective.
See reverse side la atlddional insWCtions entl pualifications.
Type W baneEt repueqad (pleese d�eck a6 that apply)
� Over 65 Deduciion from Assessed Valualion
Name oi apdkaM (rn.rrer a cont2ct
4 eoP��m lhe
❑ Yes ❑ No
If name on record'n difFerarit Man iha� o( eDD�Cant iiu
Name
If No, what ia his/her asacl stiare w
m canuatt at �east one (t) ve�^
of mntrad seller (numOm aM abeeG �', state, aM ZIP wtla)
Taxing /dy� y/�ct
, //aii%/�O�rlY/(
U Ne O�GeM used arM occupieO
tds/nar residenca7
� Yes ❑ No
Was lhe appGqrif 65 yean of ape or mora on DecamEer 31 of the year
DtiOr t0 tlie airtant yee(7
� Yes ❑ No
Adjusted gross income of appliwn; spouse, and any
individuals sharing ownership (FOr Over 65 deduction, income
may not exceed 525,000; for the Ovar 65 Circuif Breaker Credit,
income may rat exceed 530,0007or individuals, or 540.000 (or
married couples).
s.��
Hava yw filad ior e�ry oiher tleducCOns7
� Yes
Have you fded ta OeCuctiona In any Wher couMy4
� YeS
❑ No
,� .
�cOver 65 Circuit Breaker Credit
H owned vrith aaneone oiher than spouse.
indiwta with wtwm
�al properry � Mobile home (IC 6-7-7-�
Record number Page number
- „ _
AssesseE value of lhe property as of arc
forO�er 65 deduCion, or Sf 60.000IOr Ne
/
Source of Inwme Amount of Income
IS
Ig
TOTAL S 3�� �/ 0.00
If Yes, what dedudonsT
I/We certify under penalty of perjury that the above and foregoing information is true and cortecl and that the applicant was a �esident
�of Indiana and owner of the aforementioned property on March 1. 20 _
Signatura of aop�icartl Mdress of ao0���� N�+Dm eib sheof. ciry, sfate, aM ZIP wde)
o.�:�. . 01� ✓vwcm, 3 � S � � .$fi�.-.�" ,$�'. .� �16 �10
• Synature o7 authorized represenialive Address of aulMnzed reo�senta�ive (nomberan0 shecf. ciry, stato, and ZIP cotle)
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