HomeMy WebLinkAboutAge_Douglas Th. w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP ) YEAR
i PROPERTY TAX BENEFITS
.... FILE])
State Form 43708(R9/9-08)u Prescribed by the Department of Local Government Finance
2 File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. MAR 2 0 2014
INSTRUCTIONS:
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 deductiop is to
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as rea/[Pi PBAYP' tl h4 X6Tas
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefi requested(please Heck all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ap mnt(aware(or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is hisher 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 contact seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and sheet,city state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
?46 ' %� —18-4.3 -Yoci -D00_ /7&-OM
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 5160,000 for the Over 65 Circuit Breaker Credit)
12-Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If 1§/s,what deductions?
h'es ❑ No 14 5
Have you fled for deductions in any other county? If 145,what county?
❑ Yes ix 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 applicant Address of applicant (number and street.city state,and ZIP code)
J Q,,SI WSJ Vaji aeso . Td.13/. and o -1 926 Y?
Signature of authorized representative Address of authorized representative (number and street.city,state,and ZIP code)