HomeMy WebLinkAboutAge_Royal x:..A. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
".:,''� PROPERTY TAX BENEFITS
r State Form 43706(R919-08)/406) FILED
S ...�J Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 andJe�'1.1-3f5-3./014
INSTRUCTIONS: C
To be filed in person or by mail with the County Auditor of the county where the prope 1 :fr.
Filing Dates: 1) Real Property:During the twelve(12)months before Dect fa U �� �. ct/on is to be effective.
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2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed
rearprb :During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instnrctions and qualifications.
Type of benefit requested(please check ao that apply)
Over 65 Deduction from Assessed Valuation 0 Over 65 Circuit Breaker Credit
Name of applicant(owner or contract
Is applicant the site lag or equitable owner? If o,i t 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 con ct seller(applicant must have been buying on contract at least one(1)year)
Add cjnbaer(number and street,city,state,and ZIP code) Is the property in question:
NReal property ❑ Mobile home(IC E1-1-7)
'fax' district Key number/Legal description Record number Page number
Is the property�u`s'edd 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$t60,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the appfi ant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,yeas) If filed by a surviving,unmarried spouse,
prior to the current yeaR what was the spouse's age at the time
111 Ms ❑ No of death?
Adjusted gross income of applicant,spouse,and any
, Have you filed for any other deductions? If Ws,what deductions?
❑ Yes MeNo
Have you fled for deductions in any other county? If Yes,what county?
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❑ Yes �y,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
�YrSignature of applicant Address of applicant (number and street,city,state,,and ZIP code)
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Signet of authorized representadxe Address of authorized representative (number and street,city,state,and ZIlycode)