HomeMy WebLinkAboutAge_Kell APPLICATION FOR SENIOR CITIZEN
COUNTY
YEAR I
4 PROPERTY TAX BENEFITS F I
State Form 43708(R9/9-06)
S a e Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
APR 2 6 2013
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is b-: ed.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of •:;.I. I 41rrf y;; on is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured h6IBSCJ$S 4:gri,• ,- r• 1 During the twelve(12)months
before Mann 31 of the year the deduction is to be effective. II TOR
"R
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is apprxant the 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 ❑ No
If name on record is different than that of applicant indicate below
Name of contract seller(app( t must have been buying on contract at least one(1)year)
Address of contrail seller bar and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing trio Key number I Legal description Record number Page number
/1.Uk,CQ. Qc� ale la 07-/O& �o /, /coy ;6
Is the property used and occupied primarily for
❑ Yes 'No
Mole 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 •
Signature of applicant Address of applicant (number and street,city state,and ZIP code)
/^
Signature• authorized representable Address of authorized representative (number and street,city,state,and AP code)