HomeMy WebLinkAboutAge_Jones -on' A APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR '
$ -- - 4 PROPERTY TAX BENEFITS
State Form (R9
S i
,a. 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 and IC 6-1.1-35-9.
NOV 7 2014
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is locate..•
Filing Dates: I) Real Property:During the twelve(12)months before December 31 of the 4.r.- - ..4 y j; to be effective.
2) Mobile Homes assessed under IC 6-I.1-7 or manufactured homes '_ 'et ti , .. .Artinq7OR the twelve(12)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 checkoff that apply)
aver 65 Deduction from Assessed Valuation EtlOver 65 Circuit Breaker Credit
Name of ap`GJ(owner or contract buyer) /n.rte
�y � t
Is applicant the sole legal or equitable owner! If No, 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 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:
al property ❑ Mobile home(IC 6-1-1-7)
Taxing trill Key number/Legal desorption Record number Page number
7-on z6 -/a- a'7-/03cb /- 11/O aa&
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$160,000 for the Over 65 Circuit Breaker Credit)
IgYes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
1-1 Yes 0 N
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 •
l./
Signature of a t \ Address of app5cant (number and street,city,state,and ZIP code)
G
r a ' err 0 >
Signature of authorized represe — Address of authorized representative (number and street city,stale,and ZIP code)