HomeMy WebLinkAboutAge_Earles N APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
• PROPERTY TAX BENEFITS
S ! Pre Form h (R9/9-08)
.a. Pres cribed by the Department of Local Government Finance FILE/L)
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: NOV 7 2013
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 year the deduction is to b' 11: trve.
OH 2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real pr .c:I 1. - - , . 4:)months
before March 31 of the year the deduction is to be effective. •U NTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of beneft requested(please chock all that apply) t
ligOver 65 Deduction from Assessed Valuation Icy Over 65 Circuit Breaker Credit
Name//ofappplicaannt�(ownerTLo r)
contract buye 16,—"C%6612 - _—
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
❑ 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 propeity in question:
❑
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing rid ey' \ Key number/Legal description Record number Page number
Va r,,6 dlo /A-/6 -A00 - oo/. ?90 -oz 7
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
"Yes ❑ No I
Was the applicant 65 years of age or more on December 31 of the year
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 No
IANe certify under penalty of perjury that the above and foregoing information is true and wired and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 I
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)