HomeMy WebLinkAboutAge_BaumgartAPPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
` � Sbte Fortn 43768 (R919-08)
� Pfascribed try Ne DepartmeM of Local Go�emmerit Finafxe
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Informatbm m�tained in this doament is CONFIDENTIAL pursuant W IC 61.1-12-9 and IC &1.1-35-9.
COUNN TOWNSHIP� I YEAR j
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INSTRUCTIONS �
To be fi/ed in persm or by mail with tire CountyAutlitor o/ the counry where fhe pmperty is locatetl. I' II � D
Filirrg Dstes: 1) Reel Property: Duri/g fhe tweNe (72) maNAS befrne December 37 o�the ysar the tleduction is ttltb'b/te��vA Z��9
2) Mo6ile Ho.mes assessetl urMer IC 61.7-7 or menu/adured homes rrot assessed es real pioperty: Dunry the fwaNe (72) monUis
be(ore Mardr 37 07 fhe year the detluction is to 6e eRective. `�y/6� �' �/__
See reverse side lor edddionel insbuc6ons a�M qualificatims. �� ��'
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TYOe a banere reauastaa (deese C,ewr ee �eaf eppl�
� Over 65 Deduction from Assessed Valuation
Name af
Is BDOlipnt lhe sde
buye�
;,Q vl � Oc.11irncxo�
ameR _T If No, wt�e� is his/n xad share or
❑ Yes �NO I
U name on ramrtl is diAareM Nan �ha10( aDOGCant indicsta bebw
Name ot comra t sallar (applkanf must have Deon Euying on cmvaU af bast orre (i) yaa�
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Pddress of mn C seller (numOm ard streeL ciry, smte. aM ZIP mEe)
Over 65 Circuit Breaker Credit
vnth sanaona other Ihan spouse.
witn whom
is tna o�ooeny �n auestron:
� Real property � Mobile home (IC 644-�
� Tazing disin Key num6er / Legal dascnption I RecorC num6ar Pa9e number
o'� 6-da- o a-Icn -o 00 .o �B�Y
U Ne pmpe used an0 ocwpied pnmanly for Assessed value ot lhe pro0erry as of March 1, curzenl year (may �rof exceed 5iB2,d70
hiafier residenm7 �oi O�er 65 deducfion, a 4f 60.000 /or No Ovor 65 Circuit &eekor CrediQ
❑ Yes ❑ No
Nha Iha eoM�wM 65 yean of age ar more on DecemOer 31 d lhe yeer
111bs.whatdeductions7
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I(M5. what caumy?
IlWe ceAiry under penalty of perjury that ihe above and foregoing information is true and cortect and lhat the applicant was a resident
ot Indiana and owner of the aforementioned property on March 1, 20 _
Sipnetura d appfraM AEdress of aoD��m�i (nwnDro ard sboot, ciry, sfate, and ZIP codo)
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SpnaWre uthonzed reD�enteVVa Addresa of authorize0 re0�sentativa (numborarM 5'rcref. ciry, sfafo. and LP roCa)
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