HomeMy WebLinkAboutAge_Cook E APPLICATION FOR SENIOR CITIZEN r' I �fOU1fy)r� TOWNSHIP YEAR •
PROPERTY TAX BENEFITS (A�y R�s
_/ sate Fa=43708(R9/9-08)
S idle/ Prescribed by the Department of Local Government Finance
APR 14 2014 1 File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. �1 ���
INSTRUCTIONS: es,Lrtf,-YJ[
To be Med in person or by mail with the County Auditor of the county where the property isGnalBON COUNTY AUDIIOP
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be e ec
2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real properly:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instnctions and qualifications.
Type of benefit requested(please check a0 that apply)
1 Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
ame of applicant or contract buyer) eatit
IK Is applicant the ole legal or e legal ore t is his/her exact share or interest? If owned with someone other than spouse,
p9Yes with whom
I�d/Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(a /cant must have been buying on contract at least one(f)year)
Address of contract se er(num�street,city,state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing distri Key number/Legal description Record number Page number
• �# /• act-oa- --aco-000.1sv-o19
Is the property used j occupied primarily for fAosr s Oss
vee6 5 v addu octf iohne,por roert,a00 o f fo MO 1v,cr u rrCir cua r&masy ke nor Creecit e)e
d 5182,430
his/her residence? j4
Yes ❑ No
Was the applicant 65 years of age or mom on December 31 of the year
❑ Yes 1 yJ4o
IAVe certify under penalty of perjury that the above and foregoing infomiation 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 t Address of appr�nt,(number and street,city,state,and ZIP code)
�� �Y� �° /a a /r/ , bzicipmeig
Signature of authorized representative Address of authorized representative (number and shoot city,state,and ZIP code)