HomeMy WebLinkAboutAge_Strawd�--'� q APPLICATION FOR SENIOR CITIZEN
rb =_. PROPERTY TAX BENEFITS
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�`� ��. i' State Form 43708 (R70 / 12-OB)
'� eu ° Prescnbed by the Department of Local Govemment Finance
Infortnation contained in this document is CONFIDENTIAL pursuani to IC 6-�.1-12-9 and IC 6-7.135-9.
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File
DEC 31 �m�
INSTRUCTIONS:
To be (led in person or by mail with the CountyAuditor o/!he county where the property is located. �!
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Filing Da[es: i) Real Property: Dunng the twelve (72) months before December 31 of the year the de�g�;s���,�
2) Mobile Homes assessed under IC 64.1-7 or manu/actured homes not assessed as real property:
before March 37 of the year the deduction is to be eBective.
See reverse side for additional instructions and qualifications.
Type of beneft requested (please check all fhat apply)
�Over 65 Deduction from Assessed Valuation }� Over 65 Circuit Breaker Credit
Name of applicant (owner or contract buyerJ
' , C �/�
Is appli nt the sole I al or equitable owner? If No, what is his/her exact share or interest? If owned with someone oNer
indicate with whom
❑ Yes ❑ No
If name on record is diRerent than that of applicant, indiwte below
Name of contrect seller (applicant must have been buying on cont2ct at least one (7J year)
Address of contract seller (number and street, city, state, and ZIP code)
Taxing district � Key number / Legal desaiption
`� ot� - I�-/a - /O Y-000. ,
Is lhe property used and occupied Orimarily for Assessed value of ihe
hisRier residence? Ior Ove� 65 deduction,
,�Yes ❑ No
Was the applicant 65 years of age or more on December 37 oF the year
pnor to ihe year taxes are firet due and payable?
�, Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (For Ove� 65 deduction, income
may not exceed 525,000; for the Over 65 Circuit Breake� Credit,
income may not exceed 530,000 (orindividuals, or S40,000 for
mamed couples).
Have you file0 for any other deductions?
�es ❑ No
Have you fled for deductions in any olher county?
❑ Yes � No
Is the pmperty in queslion:
❑ Real property ❑
Rewrd number
/O —U l-� $
ApplicanPs date of birth (month, day year)
�_�0-33
Source of Income
.. .
If Yes, what detluctions?
/ 1 �
If Yes, what wunty?
If fled by a
what was tl
oF death?
5
S
TOTAL $
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the 2
of Indiana and owner of the aforementioned propeRy on March 1, 20
Signature of applicant Address of appliwnt (numberand streef, city, state, and ZIP wde)
7'/% ' C. /� 2 : �'
Signature authorized representative Address o�F a7uNOrized represeNative (nu er and street city, state, and ZIP
V //l�//A n�iw'v[ i . .. 'Y_ . .
YEAR
�'R�nonths
spause,
�ile home (IC 6-1-7-�
Page number
5782,430
nmarried spouse,
age at the time
of Income
'� � �
was a resident