HomeMy WebLinkAboutAge_Hall . a;"o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR '
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? J' PROPERTY TAX BENEFITS
'- �- Slate Form 43708(R9/9-08)
mix S f Prescribed by the Department of Local Government Finance FILED
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. AUG 2 8 2013
INSTRUCTIONS: 8
To be tiled 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 year the d �: :--]S..
e���� ' • §iv44 1'TMErths
2) Mobile Homes assessed under IC 6r7.7-7 or manufactured homes not assessed as real property � ring
before March 37 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(p1 check all that apply)
Over 65 Deduction from Assessed Valuation fiver 65 Circuit Breaker Credit
Name of applicant(ow(nne eerr//�wJ,,'f/p/y�/tract
/'1buyer)
,a/ -at-te- e`''�-'/yam//+
Is applicant the sole legal or equitable owner? If N0.what is hishier<7 exact share or interest? If owned with swneone other than spouse,
indicate with whom
❑ Yes 0 N
If name on record is different than that of applicant,indicate below
Name of contract eller(applicant must have been buying on contract at least one(1)year)
Address (number and street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 5-1-1-7)
Tax. 'stria /� Key number/Legal description Record number Page number
//// �7 �L ac.-o4-1a-Wo m 3s-ag
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
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 Applicant's date of birth(month,day,year) If filed by a surviving,unrraried spouse,
prior to the current yeaR what was the spouse's age at the time
❑ Yes ❑ No of death?
Adjusted gross income of applicant, spouse,and any
❑ Yes 1 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 a plcant Address of applicant (number and street.city,state,and ZIP code)
S'S.3 1
k 1/'�'(J' ��'iy/ �c�j/d d �e Y7 lf� sit I �e� �n � 76 d
S La ulhwrzed na' ` dress of authorized resentathe (number and street,city,state,and ZIP code)