HomeMy WebLinkAboutAge_Pearson APPLICATION FOR SENIOR CITIZEN i ;lli�°rillal YEAR
•`F A i PROPERTY TAX BENEFITS .l�i
'W'...:2-- State Form 43708(R9/9-08)
71.1 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:
To be filed in person or by mail with the CountyAuditor of the county where the property is located. OI BSO N COUNTY AUDITOR
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
Name of contred seller(applicant must have been buying an 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 6-1-1-7)
Tax' strict Key number I Legal description Record number Page number
4, -05 -W -/0? -000- 3(0 -oA7
Is the property used and occupied prSmariy for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,a$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
Have you filed for any other deductions? If Yes,what deductions?
Yes ❑ No N 5
Have you filed for deductions in any other county? if Yes,what county?
❑ Yes Lg.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)
K t ka Q c. hP Xa71' 4,stw-f€, 1-4)41) 65 lAidcA,s1-1. 41foGG6
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)