HomeMy WebLinkAboutAge_King "1.. A. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR '
e:` `4� PROPERTY TAX BENEFITS
:.
'a State Fonn 43708(R9/9-08)
•��'Sr`, In /,a. i Pi ',4 Prescribed by the Department of Local Government Finance ;
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. f a ..
INSTRUCTIONS: MAY 1 t7 2013
To be filed in person or by mail with the CountyAuditor of the county where the properly is located.
Filing Dates: 1) Real Property::During the twelve(12)months before December 31 of the year the deduction is to beer 1$..•_i ,
2) Mobile Homes assessed under IC 6-I.1-7 or manufactured homes not assessed as real prope4$90 '•-'P 1 t. oaths
before March 31 of the year the deduction is to be effective. NTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Over 65 Deduction from Assessed Valuation ‘El-Over 65 Circuit Breaker Credit
Name of applicant( TTT"' contract buyer) (� /, �m el 39
Is applicant the a legal or equitable armor? 0 No,what is his il•xad share or interest? U If owned with someone other than spouse,
indicate with whom
El Yes ❑ No
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:
' t':I property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
6 & -v3—/3 —'Jo; 00/.0189-007
Is the property used and occupied prima' for Assessed value of the properly as of March 1,current year(may not exceed 5162,430
his/her residence? for Over 65 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
Have you filed for any other deductions? i�- ' If Yes,what deductions?
❑ YeS Lg310
Have you filed for deductions in any other county? IIITIIII��� If Yes,what county?
❑ Yes I ,lo
IM/e 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)
Y1411-14-4/ilAA;•) ..A.0-r)'\ iiq il. A Jcrw. d3&ea.-) (._4' i ,t, ' `/1664
Signature of representative J Address of authorized representative (number and street,city,state,and ZIP code)