HomeMy WebLinkAboutAge_Kent APPLICATION FOR SENIOR CITIZEN� g I( .1 TOWNSHIP YEAR
�' PROPERTY TAX BENEFITS Cpl
: State Form 43708(R9/9-08)
Prescribed by the Department of Local Government Finance
APR 0 'Z013 File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: ' , -mot
To be filed in person or by mail with the County Auditor of the county where the property Ar ;t CrbNTY AUQITOR
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 0 :ar a`rf ucbon is to oe effective.
2) Mobile Homes assessed under IC 6.1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before Mardi 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
AnOver 65 Deduction from Assessed Valuation ®;Over 65 Circuit Breaker Credit
Name of .- (owner dca,fractguyed
annez Si
Is app ••e a sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes 0 N
If name on record is different than that of applicant indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street,city:state,and ZIP code) Is the property in question:
I Teal property ❑ Mobile home(IC 6-1-1-7)
Taxing di Key number I Legal description /Record number Page number
7'� dkr' oy-,Q5-/o/ 000 i7y oao
Is the property used and occupied primarily for
❑ Yes 0 No
I/We certify 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 the aforementioned property on March 1,20
�Siignattuure of applicant Address of applicant (number and street,city,state,and ZIP code)
I\Fam"`-' ie l�"_ 3o( S , %r.aRya Ant, O?. 7'9 road's: r-u 117G4- G-.
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)