HomeMy WebLinkAboutAge_Spore� APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � YEAR
. PROPERTY TAX BENEFITS � �
` ' Sbte Fortn 43708 (R9 / 9-08)
Presaibed by the Departmenl of Loal Govemmerit Finance
File Mark
Infortnation wntained in Nis dowment is CONFIDENTIAL pursuant to IC G1.1-12-9 and IC 6-7.135-9. MAV'7 ��0��
fil 1
�
INSTRUCTIONS: C �
To be filed in person or by mail wilh Ure CountyAudrta ol the county where Ure propeMy is loca[ed.
Filiry Dates: 1) Real Property: Durirg the tweNe (72) months be(ore December 31 o71he year the deducfion isl�a1 fe1frNeclive.
� 2) Mobile Homes essessetl urMer IC 57.1-7 or man�fectured homes rrof assessed as real properfy.� �7ing��IT%(AjJp}'��
betore Mardr 37 0! the yeer the detluction is to be eflective.
See �everse sitle ta atltlitional iruWClions eIM qualifications.
Type N be�reH repuested eese Mach e9 fhaf apply)
Nama ol mM2d se0er (applicanf mus( have beon Ouying an cantraG af kast orie (1) yvarJ
' Pddreas ol mntraq seller (numborerW sbeet city, sfato, antl ZIP wCe) Is tha D�oerty in Question:
Real property � Mobile home (IC 6-14-n
w�i�e du�na Key num6er / Legal description ecord number Page r.umher
-o - o - �a3 .3 � - ��a'
ia me o�veM used ana occupea �rimariy ror Assessed value af the O�Oe�ty as ot Ma¢h 7, cuRent year (may wf erceetl 5iB1,<30
hiNher residenw7 Ior O�er 65 deductiun, or Sf66.000 for the O�er 65 Circuil &oaker Credi�
❑ Yes ❑ No
Waa the eoM� 65 yeaB ot age or more on December 31 of lhe year ApDIi�nYs date of biM (mmN, day, yoa� If filed by a surviving, ur..mamed soousa.
prior lo Me arterq yeaR wha� was the sDOUSe's age at the time
❑ Yes ❑ No , oteeau,?
�-
Adjusted gross inwme of appliwnR spouse, and any Source oi Inwme Amount oi Income
individuals sharing ownership (For Over 65 deduction, income S
may not exceed 525,000; lor the Over 65 Circuit Breaker Credit,
income may not exceed $30,000 lor individuals, or 540,000 for g
married couples). �—S '
' TOTAL $ 0.00
Have you Ned tor a(ry olher Cetluctims4 II T§s, v.fiat dedvctionst
❑Yes ❑No �
Mave you filed (or deductioro in any other couMy? �f 1§s, what wumy7
❑Yes ❑No
IM/e cerlify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a residenl
of Indiana and owner ot the aforementioned property on March 1, 20
' Sipnatu d eppikaM ' AdEress of epplimm (nunDer erH s6ee4 ary. sfate. aM ZlP wde) '/�7 /�
�T LLr!
�, - `7��E S� e i .�
pnatura of eNhorized repreaeritaUve Addrasa of eNhmizad re0�asenfative (numDOraM 5lroof. city, state, and ZIPCOOo)