HomeMy WebLinkAboutAge_Woods, APPLICATION FOR SENIOR CITIZEN (� \� u ow veArt �
PROPERTYTAXBENEFITS \ ,y
(S _. ,�' Stale Fortn a3708 (R9 / 408) � J
� Prauribed 6y Iha Department o( local GovemmeM Finance '
In`ortnatiom m�tained in Ihls doament is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC 6-1.7-35-9. MAY �e M2�1� �O
INSTRUCTIONS: �-yn� � �/
To be filetl !n person or b mail wrth the Coun Audita o7 the coun where fhe � ��K�
y ty ry propertyislocated. O' ��
Filirg Dales: 7J Real Property: Dunrg Ne M1veNe (12) mwdhs 6e/ore Decem6er 3f o/the ysar flie deduction is��g�r�'a��NTY AUDITOR
2) Mobde Hanes assessed under IC &7. 7-7 or manNacturetl homes �rot assessetl as real properfy: Dunng fhe tweNe (72) monNs
be/wa March 37 07 the year the deduction is to 6e eRective.
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See ieverse sitle lor adddional instrodions arM qualificetlons.
Type W banafi �uested oase rhack eH Naf app�yj - _. .
Over 65 Daduction 6om Assessed Valuation ,�j Over 65 Circuit Breaker Credit
NamBOfeODP nt(rnmeracmtrdcl0uyo�
Q' l/`i
Is appl�rit the sde lepal or epuita ovmeR If No, whai is �isRiar exaa share w interest? If o.med wiih someone oiher than soouse.
indiotawithwhom .
❑ Yes ❑ No
H name on recortf is diflarem Nan Ihat d aodKant ��dicate Selow
�
Nama d contad seAer (appl'rcanf must ha�e Doon bvyirg m cmf'ad af least orro (1) yea�
Addrass ot wntrad mller (numbora� sbeet, city, sblo, eM ZlPcvde) Is ina p`opeM �n uuastion:
� Real pmperty � Mobile home (IC 644-�
Tazin tl triU , KeynumGer/lepaldescnplion Recordnumber Pagenumber
/�.�ori- �-ia-o7-3o�f-ooa.o i-oa8
Is the WopeM �� arW occupied prvnarily 1or Assessed value of the prope(ty as of Ma�ch 1, wrrerl year (may rrof oxceed 5782.a30
his/ner rasiden�? hrO�er 65 tlatlurfim. u 5760.000 hr Ne Ovar 65 Circuif &eakw Cred�
❑ Yes ❑ No
Was lhe epplicarrt 65 yaara of ape w mwe on December oF the year
Have you fled tor any dhar dad�ctions9 Ii Vaa, what deductions7 �
_.`�5 � ❑NO . N.S. . . ... ..._ .
Have you fded fw deductbns in eny other county? If T§s. what courrty? �
� ❑Yes ❑No . _, � _
IIWe certify under penalty of perjury that lhe above and toregoing infortnation�is irue and cortect and that the appiicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
SignatureWepplicaM _. -- — -- Atltlrassofaoo���t(numbmaiMsboot,ciry,SWta.eMZlPcode) �
C��l� 2�a .��
Signature of authwiz raD�eseMative , Address ot authorized representative (numbera�M street. cily, sfate. antl ZIP coCe)