HomeMy WebLinkAboutAge_Sillery� ": APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR
� PROPERTY TAX BENEFITS g�� y�
Stafe Form 43708 (R919-08) JL 1J
S a�. � Pfascnbed by the Dapartmem of Local Govemmem Financa
File M[ark
Infwmation wnleined in this doament is CONFIDENTIAL pursuant lo IC 6-1.1-12�9 and IC 6-1.135-9. MAY J 20��
INSTRUCTIONS: C , �, n�
To be filed in persm or by mail with fhe CourttyAUQita o/ fhe county where the property is located.
Filiry Dates: 1) Real PropeRy: Ouriry the tweNe (72) mwrths belore December 37 of fhe year the deducUon is to b�g @y�. n�� �A� I1I
2) Mobile Hpnes essessed urMei IL 67.1-7 ar manu/ectured hwnes irof assessed es real property.' unng e t eT � mp7{�+S70R
be(we Ma/c!r 37 0/ the year the deduction is to be eflective.
See reverse sitle lor edditionel inSWdions arM qualificaUons.
Type of benefit repuested (please theck e0 Net epply) '
�-Ovar 65 Deduction hom Assessed Valuation � Over 65 Circuit Breaker Credit
Nameofapd�� ctDU�-���ef��:.i� /
V
la epulitaM lhe ade lepal or e4uitaWe owne(! If No, what' is�her erzaG share w L�ta:est9 H owned with swneone
indimta with whom
❑ Yes ❑ No
H name on record ia diflurem Man Mat of eopFfanL indicate balow
Name of conlad seller (epp4cant musf hare been Duy'up on conbacf et loast orre (1) yea�
Pdtlress of mntrad eetler (number end atreeL tiry. s6b. eM ZIP code)
O�oeM in duestion:
spousa.
� Real property � Mobile home (IC 644-7)
Tazing is nct ` Key num6er / Legal dascnption I Record number Page number
6-ra . o �_�ai -aoi, y ss -
oa�I
Is ihe o�oeM used aM ocwo�ed pnmaNy br �+ssesseC value of the pro0erry as ot March 7, wrtant year (may rrof e+ceed afe7 a30
hislner �eBiEence9 Ior Ouer 65 tlatludion, a 5160,000lor Ne Over 65 Ciraol Bioake/ C2di�
�Yes ❑ No
Was the eDW�m 65 years of age or mora on Decemher 31 W the year
IIWe ceAify �nder penaly 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 �
� $ignature d✓oo�icarh
y .'
C �
Pddrasaolep0��wnt (numberaMSboeCcity.stafe,a�dZlPCOde)
Signature N a�NOnzed rapreserRative T � � Address of aulhorizaE revresentaWe (num0era�svoet, city, state, antl