HomeMy WebLinkAboutAge_Doyle"' APPLICATION FOR SENIOR CITIZEN � N , w F � r�
. PROPERTY TAX BENEFITS C .
esam F«„� <s�oa tas i soe�
� P(escribed by Ihe Departmenl ot Local Govemmenl Finance
� ��ark
Infomiatiom m�tained in this dowmenl is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC 61.1-35-9.
INSTRUCTIONS: �a�., �r,y�,
To be filed in persm or by mad with the CourrtyAuditw o7 Ne counry where fhe property is locafed q Q �
Filing Dates: 1) Real Prtperty: Dunrg fhe hveAre (12) months 6e1ae December 37 o/lhe year the tl�cG�9s�ior6Qb{i�,Ttr�e?UDITOR
2J Mobile Hames assessed urrdei IC 67. 7-7 or man Wactwetl homes irot essessetl as real pioperty: Dun� the tweNe (12) monfhs
be(ore March 37 0/ Ne year fhe tletluctlon is to 6e eRective.
See ravarse sitle la add'd'ronal inshudions errd qualificalions.
Type d beneN repueSteC (yleasa tliock d Ihaf epply)
� Oaer 65 Deductlon from Assessed Valuation � er 65 Circuit Breaker Credit
Name d eppGrarii (owner a conhatl buyarJ '
l''/ " — " w
b ap0���1Ihe sole lepal or epuitabla owneR I( No. w�at ia hia/ner esact e ra w interesl7 H owned with swnema Wher lhan spouse.
irMimta with whom
❑ Yes ❑ No
tt name on record'n diReraM Man Uwt d apqkan� iMicete bebw
Name d cwrtae seAer (epN'rcant must hare beon buyinp on cmuaa et roast oiro (f) yearj
P4d�ass ot mntred eeller (numbor aM sbaef, cily, sfato, entl ZIP oode) Is Ihe pro0erry in Quesiion:
�Real property � Mobile home (IC 6-7-7-�
� 7�ing i rid . Key number I Legal deacnption RecoM number Page number
i��� lo - �a.-o7- /oa - eoa. � 9-��--s
Is �he pmpeM used and oaupiad pnmarily br 0.ssaseC value ot lha Droverry as of Ma¢h 7, cunent year (may no! exceed S iB2,d30
hisThar resi0ence'! �� O�.er 65 deduCim, a Sf 60.000 /or the Ovcr 65 Ci+ctnl Breaker Credf(�
�Yes ❑ No
Was the aoWwem 65 yeen of ape or mwe on Decamber 31 d the year Aoplicanfs data of 6irth (month, day, yea� If filed by a surviving. ur.martied spouse,
prror 10 �he a�rtam yeaR / ❑ � �— �� �� �s �he spouse 5 aQe at ihe time
��j Yes No _/ o(deaihT
Adjusted gross income of appliwnt, spouse, and any Source oi inwme nrtroum ot �ncoma
individuals sharing ownership (ForOver 65 deduction, income QO p r I. I S �� (� 8�
may not exceed 525,000; for the Over 65 Circuit Breaker Credit, Q r
income may rrot exceed $30,000 for individuals, or 540,000 fw I y
married couples).
TOTAL I 5 0.00
Have you (Ja0 (w e(ry alher tletlucCOna7 It Ws. whal daEuctions?
� Yes ❑ No �" S � .
Hava you filed for deductions in any oNer cauMy? I If Yes. what wuMy?
❑ Yes ❑ No
1/We certify under penalty of perjury that the above and foregoing in(ormation is true and correcl and that the appiicant was a residenl
o( Indiana and owner of the aforementioned property on March 1, 20 '
Signature af aporicenl Eress of eoPlimnt (numDeraM stroe4 ��y, state, aM ZIP code)
� /L�/YL � . -c..C/ � � ��
$ignature W authaizeE reo�eritaWa AEErase of eNhwized reo�asa�ta�ive (number aM s' t. ciry, sta;e, antl LP crode) �� y �
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