HomeMy WebLinkAboutAge_Stone (2):_
APPLICATION FOR SENIOR CITIZEN � couNn � TOWNSHIP
PROPERTY TAX BENEFITS ���
� '• Stafe Fortn 43708 (R9/ 9-08)
� i, Prescnbed by the Depanmanf of Lacal Govemmenf Finance
I � le aiF�
Informatiom m�tained in this tloament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61.7-35-9. �
�
YEAR
INSTRUCT70N5:
To be filed in person o� by mail wrfh fhe CountyAudita o/ fhe munry where the properry is locaied. � 1 n�OO$
Filing Dates: 7) Real Property: Dunng the fweNe (12) months 6e/ore Decem6er 37 0l fhe year Ihe deduction i erpcflve
2) Mo6ile Hwnes assessed under IC 64.1-7 or manu/actured bomes not assessetl as real property: Dunng fhe hveNe (72/ months
6e/ore MarM 37 0l the year the deduc6�on is to be eHac6ve. �'��,
See reverse side (a atltlAional instiuQions erM qualifications. ��`G , �
�. I OR
Tyoe of Denafi renuesteE Id�SO Motk a0 Naf apply) � �,IgSO '
Ner 65 Deduction 6om Assessed Valuation `IJI Over 65 Circuit Breaker Credit
7�
Name of eoW� �(�� a' ���cl buye�
��� �
b 200�icarit �he sole legdl o� eQUilable Owna(7 If No, what is his/ner exact share or inlerest? It ownad wilh wmeone ciner than soovse,
inairate wilh whom
❑ Yes ❑ No
It name on racord is dif!arent Nan that o1 aodicanl indiwta uebw
Name ot
Pddress W mntratl
�C�-t �
Is Ihe pvpeM1y useC anE
hia/nar raaiden�?
buyirg on contrdcf at ba9 orre (1) yearf
(number and sLeet ci:y, stare, aM ZIP coda)
um5er/legald riotion
-/9-/�.�oa -crb.
❑ Yes ❑ No
Was lhe aoo�w�M1 65 yaars of ege or more on Decamber 31 ot the year
urior ro the airrem yean
� Yes ❑ No
Adjusted gross ineome of appliwnt, spouse, and any
indhiduals sharing ownership (ForOver 65 deduction, income
may not exceed 525,000; Ior the Over 65 Circuif Breaker Credit.
income may not exceed 530,000 for individuals, or 540,000 for
manied couples).
Nave yau fileE for any other deductions?
Mave you �led for deEVCUOns in any oiher
Yes � No
� Yes ❑ No
Assessed vatua o( the
loiOvar65 dotluIXion,
Is ine �moarty in cuestion:
Real propery � Mobile home (IC 6-7-7-�
Record num5er Paga number
3 , �,� 6
�
INVe certify under penalty of perjury thal the above and (oregoing information is true and correct and that the applicant was a resident
of indiana and owner of the aforementioned property on March 1, 20 _
Signature at a00�fam AdEress of a��licant (numDarand sf2cl, u.y, sfate, arM ZIP mde)
`�l,c�Jt ��, �tl�.c a�uu �� 50� N_ kJ-u,l.� -� f-3�� cJ� ,.�Y1. �-16 ��
SgnaWre of authodzeE raprasentative Adcrass of au�htiizac rewasentative (nvmberand s:reeq ciry, state, and ZIP cotle)