HomeMy WebLinkAboutAge_Singleton “l't. > APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR •
e -:'- PROPERTY TAX BENEFITS gy
State Form 43708(R9/9-08) I p D
•� ee ! Prescribed by the Department of Legal Government Finance $••7
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. 2 0 2014
INSTRUCTIONS: FEB f C
To be riled in person or by mail with the County Auditor of the county where the property is located. ' 2 4/
i/ h
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the dd/y(i.V. ,•li_ =(- UDITOR
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed a m•e . •unng the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of beneft requested(please check all that apply)
Over 65 Deduction from Assessed Valuation 1230ver 65 Circuit Breaker Credit
Name of applicant(armor or contract buyer) Ste//!y`7 _
Is applicant the sole legal own �If No,what is his 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 an contract at least one(1)year)
Address of contrail seller(number and street,city,state,and ZIP code) Is the property in question:
9reaal property ❑ Mobile home(IC 6-1-1-7)
Taxing d' Key number/Legal description Record number Page number
ntin . tole-ate �o a7a 3�� -oaf
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
hislher 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
of death?
Adjusted gross income of applicant, spouse,and any ' Source of Income Amount of Income
individuals sharing ownership(For Over 65 deduction,income $
may not exceed$25,000;for the Over 65 Circuit Breaker Credit,
income may not exceed$30,000 for individuals,or 540,000 for $
married couples).
TOTAL S 0.00
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you Red for deductions in any other county? If Yes,what county?
❑ Yes nNo
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
Signal of applicant Address of applicant (number and street,city,state,and ZIP code)
ct�1- 1--A- ...9, ,iks_fil,n a E� P ay. �• ti-74 C
ignature of authorized representative Address of authorized representative (number and street,city state,and ZIP code)