HomeMy WebLinkAboutAge_Payne� APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
e ' � Sbta Form 43708 (R9I408)
P�escnbed hy the Depanment ot Lacal Govemment Finance
Information contained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
COUNTY � TOWNSHIP � YEAR j
�
i e" ar
DEC 2 3 2008
INSTRUCTIONS:
To be filed in persm or by mail wdh fhe CounryAUdifor o/ the couny where the property is loca7ed. // �
Filiry Dates: 7J Real Property: Dudrx] the MreNe (12J months be/ore December 31 0l the ysar the tletluction is to 6e ecWa�1 p' �"
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2) Mobile Hwnes assessed urrder IC 67.7-7 or manulactureO nomes rrot assessed as real pmpeWBQuu��lr�i��er (k2 �
6e/ore March 31 ollhe year the deduction is to be e/fective. ��, �U
See reverse side lw atldAional instniQions aIM qualifications.
Type W banefit repuested (/.doeso Mock e6 Mef app�
�Over 65 Deduciion hom Assessed Valuation �ver 65 Circuit Breaker Credit
N e a ecd�m (o»,a. d�o�r�« e�yo� �
�rn,c� °d iCG`."' - -.. �
b oircam me wie iagai or eQU�tabie a«nan If No, what is hislher exad share or ints:esti If uxneC witn mreona ot�er than 50ovse,
indi�ta w�in a^om
❑ Yes ❑ No
II nama on record is diflarent Nan ihat of aooliwnt �ndicata beiow
Name of cont2ct seiler (apd�wn( mvst Azre Daen cuyirg on conVacf et loa9 orro (�J yca�
� Pdtlrass W tontratl sellar (numbw aM sbeet, crty. saro, aM Z/P mW) Is tne �moe(ty in cuestion:
Real pmperty ❑ Mobile home (IC 644-n
i disincl I Kay number I Legal tlescnotion � Record number Paga r.uroxr
� ���� �-id i8 3�a-�a��o.o��j
Is me orooenY useC and occuped pnmady kr 0.ssessed value of the �:opertY as of Marc" �, wnar.f year (mny not er�d 5182430
his/nar eesiEance? (or O�er 65 dodvuion. w 5f60.000 (oilhe Over 65 Circuif &eakor Crcvi�
Yes ❑ No
Was the aoo���165 years of age w mwa on Deeembar 3t d tne year
Have you fiied for ay othar detlucUOns7 If Yes, what deduciior.s?
�j �s ❑ Na ,�S �
Mava you filed tw deEUCtions in any olher county7 If Ves, wnat counry?
� Yes ❑ No
INVe certify under penalty ot perjury that the above and (oregoing information is We and correct and thal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�Sgnat appGCarit dress of a001inrt (numbefanC sboct, ury. slafe. and rotl ,
� �
n � .�.� �'�
ignaNrB N auNOnxed (BO�Sentelive Atldrasa of authorizec raorasentative (namDOra�M s:reeq ci,y, 5ate, and ZIP codo)