Age_Conaway APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
j PROPERTY TAX BENEFITS g
''" State rb Prescribed by 43708
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® Sto For by the (Re I mere 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.
JAN 2 2013
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor 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 t•C; --=-' 4 ri
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as rea . "of ;vol.,: ^ U)skont s
before March 31 of the year the deduction is to be effective. �I UU
See reverse side for additional instnrrlions and qualifications.
Type of benefit requested(please check an that apply)
cgiOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyed
0.
c.„- bard L CGnQwct
Is applicant the sole legal or equitable owner? If No,what 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 saner(number and skeet city,stabs,and ZIP code) Is the properly in question:
xiReal property ❑ Mobile home(IC 6-1-1-7)
do 'Ea zing district �p Key number I Legal description Record number Page number
U9CIA l 8 (o-
Is the property used and occupied prima h br a trim -Ig 3Ga -000 cn�br Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
lc Yes ❑ No O
Was the applicant 65 years of age or more on December 31 of the year Applicant'
El Yes No
Have you fled for deductions in any other county? If Yes,what county?
❑ Yes ® 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
Signatu applicant Address of applicant (number and skeet city,state,and ZIP code)
ti 660
Signature of authorized mpresentativ Address of authorized representative number and street,nty,'atate,and ZIP code)