HomeMy WebLinkAboutAge_St. Clair� APPLICATION FOR SENIOR CITIZEN
- PROPERTY TAX BENEFITS
•� � Sbie Fortn 43708 (R9 / 9-08)
� ,' �.i � Prescnbed by Ne Deparimerit of Lxal Go�emmeM Fnance
Informatiom m�tained in this document is CONFIDENTWL pursuant to IC G7.1-72-9 and IC 61.135-9.
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COUNTY TOWNSHIP YEAR
MSTRUCTIONS: � � �F��
To 6e filed in person or by mail wifh the CountyAudRor of the oounty whele fhe popeffy is located. /� pp p � O��
Filirrg Dates: 7) Real Property: Dunng the hveNe (12) maMhs 6e7ore Oecem6er 31 0! the ysar the deduc(ion is to 64�§HAbtil§.
2) Mobile Homes assessed urMer IC 6-7.7-7 or manWac[uretl homes not assessed as real property: D�uirp� f�,e� ��Om�(12) months
hefore Marrh 37 0l the year fhe deduction is to be eNecfive. C: �a�i�jr-_..��
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See reverse sitle tor adddiona/ insWdions and qualfications. V
i T iT R
Type d beneEt requasted (ploase Meck a� fhat apply)
� Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
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Is app6mM lhe sde legal uitaGe owneR tl No, what is hisTher exaU share or'vrterest7 It owned with sane�
❑ Yes ❑ No I
If name on racad is difieram Ihan that d appGcant irMkate beb«
Name o( carimct seller (app/manf musf hava been Duyirg on contrsd af /east orm (1J yeaQ
Pdd:ess d cvntrad wller (numDV� arid sbseG �+�y, sbte, and LP wde)
Is ihe pmperty used aM acwpied primanty br
hivhettesidents7
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Signature d euth 'zed representativa
Key numbaz / Legal Descnplion
❑ Yes ❑ No
Is tha pmperty in 9uestirn:
� Real pmperty � Mobile home (!C S74-n
Record number PaBe number
a-/o s�oad.7.33 �� �
Assessetl value o( the pmDerry as of Mairh 7, eurtant year (may irof exceetl f182,a30
tor Orer 65 tlotl�Cim, w 5760,000 !or Ne Over 65 C"ucv"d Bioakor CiadiQ
a of birth (morrth. day,
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�Source of Inwme
,My?
If filed by a wrviving, unmartied spouse,
what was Ne spouse'e age at 1ha time
of death?
Amou'rt of Incoma
$
$
TOTAL 5 �S'��� 0.00
We and cortect and lhat the applicant was a resident
:beet, riry, sfafe. anE ZIP wde)
� I X �D Q l� , � ��.c�--�i- �' /�%
Address of aWhorrzad representativa (numberaiMrtl stmef, cify, 4ate, and LP cado)