HomeMy WebLinkAboutAge_WoodruffAPPLICATION FOR SENIOR CITIZEN
, PROPERTY TAX BENEFITS
� State Fortn a370B (R9l 9-08)
� u, � Presaibed try ihe Departmertl of Local Govemmem Finarke
Infortnatbm m�tainetl in this Eoament is CONPIDEN7IAL pursuani to IC 6-1.L12-9 and IC 6-1.7-35-9.
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INSTRUC710NS: ��„ ,,,��
To 6e fi/ed In person or by mail wdh fhe CountyAutlrtw o/ Ne county where the propeRy is locafetl. �R�C �/ �
Filing Detss: i) Rea1 PrvpeRy: Dunrg Ure AveNe (72) months be(ore Decembe� 37 ollhe year Ihe detlucUorn�Sid�e�� ���TY AUDITOR
2J Mobile Homes essessed urMer IC 6-7.1-7 ormanulactured homes rro( assessed es real propeAy: Dunrg fhe AveNe (72) monflis
6e(are March 31 0! the year the tletluctlon is to be eflective.
See reverse side lor edddionel lnsWdions aM qualifications.
Type of berrefit repue5ed (please MorJC aC Naf appl�
� Over 65 Deduction 6om Assessed Valuation � er 65 Circuit Breaker Credil
Name of apd��1(owr� a canGac( Avye�
P w
Is epDGmm Iha wle al or eQUitaMe amel7 tl No, whal u hurtier ezad s�are or iriterast'! H ownad xith someone ocher lhan spouse,
intlirete w�ih whom
❑ Yes ❑ No
H�me an reco'd is diftaraM tlun Nat o( aDp&ant, indicete beb«
Name of contrea ael�er (epdirant must have Doon e�yiig m canvact et /aest orre (t) yea�
Addreas ol contratl sellar (numbw aM sGee; cify, stab, eM Z/P wde) Is the prooerty in Question:
� Real property � Mobile �ome (IC 6-14-7)
� 7y�ug al n � Key num6er I legal desuiDtbn Record number Page numbar
���in.C��� �_ i d.ot�-3o/-003..3o9-od 8
U u�e omveM used a�e occupee orimariy m. AssesseC value ol the pmpeM as of Ma�ch 1, cur.em year (may irof orcced SiHi a30
hislher reaiden�7 �orO�er 65 tletlueion, a S 760,000 !or No Owr 65 Circuil &oaker CreQif)
� Yes ❑ No
Wav the aOW�wn165 yean af aga or mae on December 31 oi Ihe year Aoo���fs dale
� �� otdeaN?
Adjusted gross income of applican; spouse, and any Source of income amount oi mcome
individuals sharing ownership (ForOver 65 deduction, income �O S a O 5 �
may not exceed 825,000; for the Over 65 Circuit Breaker Credit,
income may not exceed 530, 000 for individuals, or 540,000 for I S
martied couples).
I TOTAL �$�D S% S 0.00
riava y«� fil.a ror em ancr dmucea,sa �r Yes, w+,a� daauctio�s7
�5 p No H .5
Have you fJetl tw tladucCOns in any other cwmy7 If l§s, what caunty?
❑ Yes �No
I/We ceAify under penalty of peryury that the above and foregoing information is We and cortect and that tha applicant was a resident
of Indiana and owner ot the aforementioned property on March 1, 20 �
SlgneturedappfraM MdressotapplimM (numbmentlsboot,city,sfafe,aMZ/PCOdo)
���� �, � R e r�. t� 46 81�
Sipnatu�e af euthor¢eE feD�esentawe Addreas of authwized reo�asen tive (numDOraM sboot �, stafe. and LP cotle)