HomeMy WebLinkAboutAge_Townsend y - '%"v APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
't'':1 PROPERTY TAX BENEFITS
• ::;,_ State Foan 43708(R9/9-08) —
S tee ' 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.
MAY 9 2013
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor 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 d
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assess3(g8€0,pere(MolinAeo (12)months
before March 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)
EXOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contrast buu�yer)
Is applicant the sole legal�uitableeoowner? If is hisAier�or interest? If owned with someone other than spouse,
(?Q es with whom
LAYes ❑ No
If name on record is different than that of applicant,indicate below
Name of(=tract seller( t must have been buying on contract at least one(1)year)
apt:
Address of contra er t,city,state,and ZIP code) Is the property in question:
n Real property ❑ Mobile home(IC 6-1-1-7)
Tazin 40'. Key number I Legal description Record number Page number
/ 0 F9 61—/a-o7- qoa -oo3.cW-od8
Is the property used and occupied p imar*y for Assessed value of the property as of March 1,(rtent year(may not axed 5182,430
his/her residence? for Over65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If filed by a surviving,unnamed spouse,
prior to the current yeaR what was the spouse's age at the tune
❑ Yes ❑ No of death?
Adjusted gross income of applicant, spouse,and any _
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ,No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ve L�}Jo
IIWe 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 rode)
\ICSA-*L2-19 tz 716E , .
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)