HomeMy WebLinkAboutAge_Sims • a.e i APPLICATION FOR SENIOR CITIZEN - COUNTY TOW P I YEAR
PROPERTY TAX BENEFITS itA�jlliel)
State Forth 43708(R9l 9-08)
Prescribed by the Department of Local Government Finance i
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. MAY re tylyfirh•((Ull3�
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deductio6Jra
UDDNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of beneft requested�(please Meek all that apply)
W Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant 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
111 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 suer(number and street,city,state,and ZIP code) Is the properly in question:
y`l Real property ❑ Mobile home(IC 6-1-1-7)
Taxi district Key number/Legal description Record number Page number
Is the property used and occupied primarily br
Have you filed for any other deductions? If Yes,/whaatt deductions?
xi Yes 111 No /`C
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes '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 •
Signature of applicant Address of applicant (number and street city,state,and ZIP code)
?C �t QQ,�.m.St.,rY,,, K 4 O N r)'"4 ST. C,UEn)SlffC (e /kJ trXelaS
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)