HomeMy WebLinkAboutAge_SpechtAPPLICATION FOR SENIOR CITIZEN � couNn TOWNSHIP venr�
- PROPERTY TAX BENEFITS � �
` ' Sfate Fortn 43708 (R9 / 9-08)
� �� P�ascnbed by the DepaRmem of local Go�emmem Finarxe
File Mark
Infwmatiom m�teined in this doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9. � U N 2•� 2��9
INSTRUCTIONS: v
To 6e fi/ed in person or 6y mail xith Ure CountyAud'Ra of fhe wunty where the property is locafed. �%a� �/�✓�
Filirq Dafes: 1) Real Property: Duriry the tweNe (72) marths befae December 37 0/ the year the tletl��p i; f rhe a�A�e�cTtive. p���nIi �
2) Mobile Homes essessed urrder IG fi7.7-7 or menulactured homes rrot assessed as ree7p�iope�'D3rmg thY Mtii76 (�months
belwe March 37 07 Ne year the tleduction is to 6e el7eCtive.
See reverse side lor edditional lnst`uUions arrd qualifications.
troe a narreN rea�aslm (d�sa rlioc/r m uiat avaM
❑ Over 65 Deduction from Assessed Valuatlon �.pver 65 Circuit Breaker Credit
Name of apd�M (ovmer a contracl DuyorJ Q
/�a'lfi✓�-f/� / /'�.l�Ci(.Y ' _ _ _ / _
Is aoo��nt the sda leqal or eavitade owneR It No, what ia hisRier azad share or imeresl7 H axned wiih saneone other Ihan spouse.
indimta with whom
❑ Yes ❑ No
tt name m recoid "u diftarem itian Ihat d appGcan� inOicate bebw
Name of wntacl se0er (applicant musf hare been buyiip on con4att at loasf orro (i) yearj
lddrass d mntrad ae0er (n'anbar arW abaet cdy. stafe, an0 Z/P mtle) is me o�ooerry in aues2bn:
� Real property � Mobile home QC 6-14-�
� Taxing district Key number / Lepal tlescnption Record numbar Page number
� . d� 79-/�-/o/-oo/•/ -� o� �
U Ne pmperty used end omped pnmarily (or Assassed value of the omperty as of Mafch 1, wrterit year (may imt exceed Sf B2.a30
hisRier res'Wence? Por O�er 65 deEUCion, m Si60.000/u/ Ne Ovor 65 C'ucuif &eaker C�ed+�
❑ Yes ❑ No
VJas the eppGwrrt 65 yavs of a8e w more on December 31 0} lhe year ApD�M's data d birth (mmN, Eay, yearf If fJed by a surviving, unrremed spouse.
prior to the airtenl yea(J � � what was Ihe spouse's age at t`e time
,�s ❑ No �{ -
Hava you fileE far arry ahar deducGonaa Ir Yas, what deductions? �
Yes ❑ No /-{- S '
Have you file7 tp deductions in any other courrty? If 1§s. what counry?
❑Yes ❑No
IIWe certify under penalty of perjury that the above and foregoing infortnation is lrue and co�ect and that the applicant was a resident '
of Indiana and owner of lhe aforementioned property on March 1, 20 _
Sipnature d appGCeM P4dresa M eoGl&art (n�mbw nM sbeef, ciry, slate, and Z/P code) '
,(�: . � �� 9i3 �/�,�.�.-- ,�f. . - . ,�/ �� ,�
�Spnatureofauth rep a Wa AdtlresaofauthorizedreD�senta�Na(numDerandsLOef.ciry,sfafo.andLPCOde)
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