HomeMy WebLinkAboutAge_RiedfordAPPLICATION FOR SENIOR CITIZEN �� co Nn TOWNSHIP � vena
� ,.-n= PROPERTY TAX BENEFITS \��. \1
, State Fortn 43708 (R9 � 408� � \�/
� PrascnbadbytheDapaA:nento(localGovemmaniFir.ance �
Infortnatiom m�tained in lhis tlocument is CONFIDENTIAL pursuant to IC 6-1.L'12-9 and IC 6-1.1- 5-9. DE ��� 1M�k2008
lNS7RUCTIONS: �y�
To be filed in persm or by mail wrfh the County Auditor ol (he munty where fhe property is locafed. %�l �� �
Filing Detes: 7) Reel Property: Dunng the fweNe (72) monfhs belore December 37 of the year the deducfion is f�q��iYe�UP!TY qUDI�OR
2) Mobile Hanes assessed urniei IC G7.7-7 or manNactured homes not assessed as real property: Dunng 1he hveNe (72) mon s
before Ma� 31 of the year the deduc6on is fo be eHective.
See reverse side 1a eddilional instrudions aM qualifications.
TyOe of beneH reQUeSetl Woase rheck a0lhat eppl�
❑ Over 65 Deduciion hom Assessed Valuation Over 65 Circuit Bieaker Credit
Nameotap Iicani�ownororconnt�raclbuyoQ , �
/ f �'
is aoPli Iha wla lepal or eQUitabie owna� f No, what is nisfner ezact share o� :^�terest9 If mHned vnth somaor.e cther Ihan spouse.
inditata with whom
❑ Yes ❑ No
It name on record is dlflaram Nan Lhat ot ao�iifanl indiwte bebw
Name of wrrtad saller (appFCanl musf haw Deon Ouyiig a: cm✓acf at lea5 oiro (t) yea�
� Pddress of mntra�] se0er (numbmaM sbeeG tiry, stato, aM ZIP mCO) Is ine omoerty in cuaslion:
� Real pmpe .ry ❑ Mobile home (IC 6-74-n
7y��� i �nq Key number / Lagat deunotion RecorC num6er Page number
a(o-�a-/8-�ol-ooa. �yo-o 7..8
Is the omaeM useE and occupied pAmany kr 0.ssessed value of Ihe orooerty as of March 1, cur.ect year (may not escoeE 5�92.<30
hisRier residenm? !m Owr 65 tlotluction. w 5 a 60.000 br Mo Ovcr 65 Circuil &Raker Gotli1)
❑ Yes ❑ No
Was the appGcam 65 years of age w mwe on Dacember 31 of Ihe year F�olimnfs date of bi�th (mon:h, day, yeaQ I If flec hy a survrvirg, unmaned s�ouse,
o�or to Ne wrrerit yea/7 whzt w�as the s0ousa's a6e ai Ihe time
�Ye5 ❑ NO � o(aeatn?
7�
Adjusted gross income of applicant, spouse, and any � Source of Income � Amount oi Income
individuals sharing ownership (ForOver 65 deduction, income O YO aDO I g�� c�� �
may not exceed $25,000; lor the Over 65 Circuit Breaker Credit,
income may rrot exceed 530,000 tor individuals, or 540,000 Ior I S
married couples).
ITOTAL I S 0.00
Have you fled tw any other deductionsY If ffis, what deductions?
Yes � No � S �iJ�
Have you filad for deductions in any othar courty? 1f Yas, what counry?
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing information is true and correcl and thai the applicant was a resident
of Indiana and owner of the aforemeniioned property on March 1, 20 _
'gnature d a�writ Pddresa of a00��r.t (numEerantl sfroet. ci:/, slalo, antl ZIP code)
'� r-v�-� �.-� �� q S�?acp St i�iwn�cs�f-�N -�- N 47(�70
Sipnature of auCionzetl reoresentalive AdCress of authonzed rao-�a�enUtive (numberantl s:reet. ciry, sfaro, and ZIP coCO)