HomeMy WebLinkAboutAge_Mason (4) '"'". APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
. -. - PROPERTY TAX BENEFITS
Statedbed 43708 Department 8) �' .,
•S ,a. ! Prescdbed by the Department of Local Government Finance - i ,.:
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
APR 15 2014
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 deduc'tic. • Arggr"
r. ,.�y' rIi
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed mi31 i••t:-,' • _ p J months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please ock all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of rylicam(owner or cantracV yyer)
yn aaor
Is app I 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(I)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number I Legal description Record number Page number
f e-all- lot- bol- f1lS0ag
Is the property used and occupied madly for .__ ch 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
Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month.day year) If fled by a surviving,unmarried spouse,
prior to the current yeaR what was the spouse's age at the time
111 Yes El No of death?
Adjusted gross income of applicant,spouse,and any
❑ Yes El No
UWe 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
Sigg!lure pplicant Address of applicant (number and sheet,city,state,and ZIP code) �RraCe17'�;
\\J1() �-' /Go3s.4 eCre 0A' �. _TN,b, 4-2 670
gnatum of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)