HomeMy WebLinkAboutAge_Morrison (5)"< APPLICATION FOR SENIOR CITIZEN
� .�. -�. . PROPERTY TAX BENEFITS
` ; State Fortn <3708 (R9 / 9-08)
Prascribed by iha DepaNnee� of loral Go�emmem Fv:ance
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Information conained in Ihis tlocvment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC 6�1.L35-9.
COUNTY TOWNSHIP � YEAR j
i I
File Mar
DEC 1 9 2008
INSTRUCTIONS:
To be filed in person or by mail wrU� fhe CountyAuditor olfhe wunry where fhe properly is locatetl. ��Jj /��!
Filing Dates: 1) Reel Property: Dunrg lhe (welve (7T) months 6e/ore Decem6er 37 of fhe ysa� the tleducfion is'to 8�6 �cZ144!`
2) Mobile Hanes assessed urMer IC 6-7.7-7 or manu/actured homes rrot assessed as re��:LP i'��� f� f�{monfhs
be/ore Marci� 37 o/fhe year the tletluc6on is l0 6e eHective.
See reverse side ta atltliUonal insUUdions end quelifications. '
Type d benefit �ecuestetl (pease cnttx a0lnat appry)
❑ Over 65 Deduction 6om Assessed Valuation
Name of app6caM (ow�rer or c rdcf Duyo�
`� c�,a, C�--^YYl �
IS dpplimM Ihe wi0legal o� eQUii2bl�ne(/ If No, wha� i4lM1at esatl sha�e ot
Yes ❑ No
If name on record is tliffarent ihan that ol aoWicanl indicate bebw
Name of cont2d spller (apqi<enl must nave baon buyirg on con:rect at Icasl ono !�l Ycaq
contrari 3eller (numhwantl sf2ef, city. SfeW, and ZIP cotle)
Over 65 Circuit Breaker Credit
If owneE wiih someona ot�er t�an soouse.
indi�ate wi�h whom
Is tne omoatry in
� Real prooery � Mobile home (IC 644-�
� Key num5er / Legal descriotion Record number Paga number
� ��-ia-�� ��_ aoa.e ,x�-�as
pnmanly kr 0.ssessed value ot the property as of Ma¢h 1, cunen� yaar (may no( erweC
!or O�er 65 tlotluIXion. w 5160.000 Ior the Ova 65 Circuit &oaker Cretlit)
❑ Yes ❑ No
i5 years ot age or mwa on Decemher 31 of the year
yaaR
� Yes ❑ No
Adjusted gross income of appliwnR spouse, and any
individuals sharing ownership (FO�Over 65 deduction, income
may not exceed 525, 000; for lhe Ove� 65 Circuif Braaker Credit,
income may not exceed 530, 000 !or individuals, or 540.000 for
married couples).
you fled for any Wher daductions?
�'S
you filed fw deductions in any aher counry?
� Yes
� No
No
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I/We certity under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of indiana and owner of lhe a(orementioned property on March 1, 20 _
SignaturedaDpllcant Adtlrassofaoplipnt (numDerantlstmeLCi.y.sfatc.anC2lPCOdo)
�°�,i .-�-z�� So E�- S �- 5��� 7
Sgnatura of auLhodzed rePresen ative ACdress of euthorized rea�esentative (numbcr antl s;rect cify, staro, and Z/P cadc)
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