HomeMy WebLinkAboutAge_Linxwiler e APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
fk: PR OPERTY TAX BENEFITS
State Form 43708(R9(9-08)
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 g�
INSTRUCTIONS: ft Ny�J I /BH
To be filed in person or by mail 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 jr thp tatetbn is to be effective.
2) Mobile Homes assessed under IC 6:1.1-7 or manufactured homes not assess as real property:During the twelve(12)months
before March 31 t the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(pease check a0 that apply) G I IBSO N G O U N I Y AU U I I OH
Over 65 Deduction from Assessed Valuation gl Over 65 Circuit Breaker Credit
Name of applicant(owner o contract buyer) v /�
CiAnol F LiKtfo lei'
Is applicM 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 ❑ No
If name on record is different"than that of applicant indicate below
Name of contract seller(a must have been buying on contract at least one(1)year)
N1 r�
Address of contract seller(number and strreef,city,state,and ZIP code) Is the property in question:
I lit Mal property ❑ Mobile home(IC 6-1-1-7)
Taxingejnct Key number/Legal description Record number Page number
P 1 1 rje a&da-o7—.03-coo Y3510d8
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
hisMer residence? for Over 65 deduction,or 5160,000 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.unmarried spouse.
prior to the anent year? what was the spouse's age at the time
❑ Yes ❑ No of death?
Adjusted gross income of applicant,spouse,and any
Have you filed for any other deductions? If Yes.what deductions?
51..Yes ❑ No i4rJ)'-1't Q _,t eL -n
Have you fled for deductions in any other county? rrr���-------IIII If Yes,what county?
}�ADtiC.
i.
❑ Yes RNo
IAVe 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)
/ •° �O• -r- •, tJ / o a nt .1.4? - .1_,rt-P/tit/M. / O L /
Signature ofauthorized repr an on 4 code)