HomeMy WebLinkAboutAge_Presnell"' 4 APPLICATION FOR SENIOR CITIZEN (� �
.S '. : ; PROPERTY TAX BENEFITS `
State Fortn d3108 (R919-08) `�
� P(escnbed by Ihe Deoartment ot Local Govemmem Finance
IMormatiom m�talneC in this dowment is CONFIDENTIAL pursuant lo IC 6-1.1-72-9 antl�
INSTRUCTIONS:
To be Ned in persm or by mail wilh the CountyAuditor o( the wunty where Ne F
FNiig Detes: i) Real PropeRy: Dunng the AveNe (12J months belore Decen
2) Mobile Hwnes assessed urrder IC 6-7. 7-7 or manu/actured
belore Mardi 31 0l the year the deduc6on is to 6e eHective.
See reverse sitle fa atldtional insWdions erM qualiAcations.
Type o1 beneft reQUest easo MeckaD Uwf app1�
Over 65 Deduciion Gom Assessed Valuation
1-35-9 )
/1 J��
A 9!
}aar fhe deUuction is to
sessed es real property:
�Over 65 Cirwit Breaker Credit
Name af apofxart (ownor or cartrac! E�ycQ �
�/��� ' V � i�i�liCL./Y�
Is aoaliom tha sole lagal or eQUitable wmaR If o, what is hislnar exad share o: L^terest7
❑ Yes ❑ No
H name on reco�d is CiRarertl Nan ihat of aodicant, irMiwte below
Name of coniad
Euyirg on convact at /oast ono (iJ yoah
r6 �
:TY AUDITOR
fweNe (72) monCis
If owned vnih w:neor.e othet ihan soouse,
ir.dinte witn vno.r.
Atldress of contratl seller (numbor antl sbeef, cify, stale, a�M ZIP mCe) Is ine pmoafty i^ ouesbon:
� Real propery � Mobile homa (IC 644-7)
Tasing disinct I Key numcer / Legal dascrio�ion I Record num�er PaBe number
�-n-/a -a�-Doo. y33� o ��-
Is U�e wooeM useC and occupeE wimar.y lor Assessec value of the orooerty as of March t. curent year (may iwt e+ccetl 5;82.a30
hisrhar rasidenw7 I�or O�er 65 daductior., or 5� 60.000lor Ne Ov�r 65 Circuif &caker Cretlin
� Yes ❑ No
Was ihe aOx�M 65 years ot age w mora on Oecember 31 d tne year
o�or ro ihe arram yean
� Yes ❑ No
Adjusted gross income of appliwnf, spouse, and any
individuals sharing ownership (FOrOver 65 deduction, income
may not exceed 525,000; Jor the Over 65 Circuit 82aker C�edif,
income may nol exceed 530,000 /or individuals, or 540.000 (or
married couples).
Have you filad tor any othar
Have you filec fw Eeductions in any other
Yes
� Yes
`
Source of Income
��
Itbes, w^a� de0uciians?
� No /� S� ��
I If Ws. wnai counry?
� No
If flea Sy a surviving, unmarried spouse.
wcat was the soouse's age zt the time
ofcaatnl
Amount of Income
Sis sa.s�
S
TOTAL I S 0.00
IIVJe certify under penalty of perjury that the above and foregoing information is We and correct and lhai the applicant was a resident
of Indiana and owne� of the aforementioned property on March t, 20 _
Sgnatura d appGCeM n �) Atldress of aopiicant (numDer antl slreet, ciry, sfalo. antl ZIP code)
Signelure d auNadz� reoresamaWa I Address of authorizad raoresen�aliva (numGer arrtl s:reet, ciry, sta(e, and