HomeMy WebLinkAboutAge_Kinman"' APPLICATION FOR SENIOR CITIZEN
;,. _. , PROPERTY TAX BENEFITS � � � � �
S '' Slate Fortn 43708 (R9 / 408)
Presuibad Cy the DeparimeM of Local Govammarit Fl nce
Informatlom m�tained in lhis doament is CONFIDENTIAL pursuant tp,�G,¢t�1-�,2-pqpQ IC 6-1.�-35-9.
IVIJV .i LUIL
COUNTY TOWNSHIP YEAR
Fle Mark
�NSrRUCnoNS:
To be lded in persm or 6y mail wrfh the CountyAudrtor o( the county �he e located.
Filing Dales: 1) Real Property: Dunng the tweNe (72) morrths be/ore Decam6 e year ihe rletluction is to be efleclire.
2� Moane Homes essessed u`aer �c s�. �-r.�&afDm�e�Yfdml�fEa3idgssed es real Properry: aniny me M�en�e (�z) rnonu,s
6e(ore Merrh 37 of fhe year the deduction is fo be eflective.
See ieverse sMe fa aeaitional inswdions arM qualificstions
Type d banef.t repue9ed (ploase Merh a9lhaf apply)
� Over 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Name d appiwant (amn or��
�.� �cn�tn-n c�
Is appGaM lhe sda lepal or eQUitaWa oxneR H No, what is his/har exatl share v irrterest7 II wmed vrith mmeone other Ihan spouse,
indimte wilh whom
❑ Yes ❑ No
If name m recnrtl is EiRererit ihan Ihal of applivn� iiWicate bebw
Nartre ot contrarl seDer (ap f musl have been buying m cmfrdct af leasf orre (i) yeaQ
�
AAtlrass d wntrad seller (numEer aM sbaeL �: stdte, aM LP code) Is Ihe pmperty in question:
� Real property � Mobile home (IC 6-1-0-�
Tazing d'Mricl Key numbar / Legal Eesrfiption RecoN numbar Page number
a �., �r� ��-tt�_g&�-o
Lv Ihe pmperty used aM ocwp priman for Aasessed value of iha properry as ol Mamh 1, lvrtent yaar (may rrot arcced 5782,430
tJSRier residenm7 foi 0`er 65 dedudion, u� 5160.000 /ur Ne O�m� 65 CBCUif &ealm/ CrediQ
Yes ❑ No
YYas Ne appl'panf 65 years ot age w rnwe on Oacamber 31 of the year Applifanfs date
� — � of d���
Adjusted gross income of applicanR spouse, and any Source ot inwma Artrount ot �ncoma
individuals sharing ownership (FOrOver65 deduction, income $ �1 iJ C�bs
may not exceed 525,000: forthe Over 65 Circuit BieakerCredit, �
income may rrot exceed 530,000 forindividuals, or 840,000 (or $
married couples).
TOTAL $ 0.00
Have you filed tu arry othar tleEUCOOns7 Ii Yes, what Oeductions7
� Y25 �o
Have yau filetl fw deductions in anY dher murrty7 If Yes. what cwrrty?
� Y25 O
I/We certify under penalty of peryury that the above and foregoing infortnalion is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signaturadapdinm AddressofaPVlicant (numDaerMsbeef,aty,slafa.aMZlPOOd¢)
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