HomeMy WebLinkAboutAge_Angle 0 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR I
e-Vt PROPERTY TAX BENEFITS
41.
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State Form 43708(R10/12-08) p
Prescribed by the Department of Local Government Finance
File- a-C
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. DEC 1 2
20;4
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the property is located. 13lpee elf Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction"1 G2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Dur1mt1o11nonths
before March 31 of the year the deduction is to be effective. ��'Y(
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Qver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name nof applicant(owner o�orrr contract buyer)
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is applicant tne sole or equitable owner? If No,wnat is his/her exact snare or interest? It owned with someone other than spouse,
indicate with whom
%Yes ❑ o
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:
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Real property ❑ Mobile home(IC 6-1-1-7)
Taxing trict Key number/Legal description Record number Page number
Is the property used an occupi d 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)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
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Have you filed for any other deductions? If Yes,what deductions? /!!
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
IMe 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 /y1 ((�1 Address of applicant (number and street.city,state,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and street.city,state,and ZIP code)