HomeMy WebLinkAboutAge_Briggs x"o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
PROPERTY TAX BENEFITS
State Form 43708(R9/9-08)
•' ,.0 Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: MAY 12 2014
To be filed in person or by mail with the CountyAuditor 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: ,fret-' . I •i
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real p er�ttyy:� •''f ell ?r 2)/months
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before March 31 of the year the deduction is to be effective. BSON C UNTY A DITO R
See reverse side for additional• buctions and qualifications.
Type of benefit requested(pf se check at that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of
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 property in question:
❑ Real property ❑ Mobile home(IC 6-I-1-7)
Taxing district Key number/Legal description Record number Page number
a6- 1%-i 304-moo. 33{•00'7
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 5160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes 111 No
Have you filed for deductions in any other county? If Yes,what county?
❑ 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
Signature o plicant Address of applicant (number and street city,state,and ZIP code) -
.
Q- /x,/02 e,ze%-a&e.-
ign um of authorized repras tative /Address of authorized representative (number and street,city,state,and ZIP code)