HomeMy WebLinkAboutAge_Davis (9)� APPLICATION FOR SENIOR CITIZEN
� PROPERTY TAX BENEFITS
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Peescnbed by Ihe Oeoartment of Local Go�emmeM Firanca
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Infwmatiom m�ained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
COUNTY � TOWNSHIP � YEAR
F M r "
iNSrRUCnoNS: DEC 1 0 2008
To be filed in person or by mail with the CountyAUtlitor o/ Bie county where the property is /ocared.
Filiry Dates: 7) Real Property: Dunrg the 7weNe (12J months befoua Decem6er 37 07 fhe year fhe deduction is fo be eN /�y
2) Mobde Homes assessed under IC G7.1-7 ormanulaUured homes not assessed as real property: Dun��tF9jfm?reWnonths
belore March 31 0/ the year the deductlon is to 6e eHective.
TOii
See reverse sitle (or add'Aional iruhucfions e� qualificafions. _. �
Type d banef.l �eCUBSteC (Weasa MMk e0 Nat app�
�er 65 Deduction from Assessed
Name of m(awner or cmvacf
\
Is aooli M the sde legabr e i C
es
If name on record is diflaran� t�an ihz
Named ntadsellar(apdiwntmi
�
P4dress mro-aa seuar ���eera
.
is
❑ No
ot ao�liwn4 indicale bebw
Ocon Duyirg a: contracf at leasf orro (t1 yea�
crty. sble. an0 Z/P wde)
`�"G��C,4--�I �1 � — r �— I�
Is Iha prooerty useE and occuo�ed pnmanly br
hislner eBSiOance?
Yes ❑ No
Was lhe eppiican165 years of aqe or more on Decembar 1 of lhe year
onor ta Uie cvrrer yea(!
Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (FOrOver 65 deduction, income
may not exceed 525,000; lor the Over 65 Circuif 82aker Credit.
income may not exceed 530, 000 tor individuals, or 540.000 for
manied caiples).
you filad for ar.y Mhar detludians?
Yes
in any other cwnty7
❑ Yes
Hava you fded tp
Over 65 Circuit Breaker �__
or ir.te:est7 If owned vnih
indicate with �
Is me orooerty in c stion:
� Real property
on I RecorC number
1 �o �O D. S65'-o�7
Mobile home QC 6-7-7-n
i 1, cur.ent year (may not ercceE 5�82.a30
Ovoi 65 Circuif &caker Cmdi!)
If Yes. x�hal daductiors?
❑ Na �(
If ffis, wha� county4
No
IIVJe ceRify under penalty of perjury lhal the above and foregoing information is We and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
vnawra ot aod"iont ACdress ot ao0��mr.i (numee�ar,tl sWCI, ci,y, s:ato, antl ZIP mtle)
Sgnature of
� z5
MZ a °^*'l
reoresentatrve
o w so
Pddress of authorizeC rawasentaliva (numEer antl s:roet, ciry, state, ar.d LP codo)