HomeMy WebLinkAboutAge_Dooley e,"'". APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR
E- ' PROPERTY TAX BENEFITS
6-• l State Form 43708(R70/12-08) -.
•�Aic�" Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. iJ
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. APR 6 2016
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property: g the twely (12)months
before March 31 of the year the deduction is to be effective. GIBS
See reverse side for additional instructions and qualifications. ON UNTY AUDITOR
Type of benefit requested check all that apply)
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:
V�L.Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description (- Record number Page number
I t. -- , , 6017Z at-193/-150A CC° 0? -Qa9
Is the property used and occupied primarily for Assessed value of the properly as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
❑ 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 .
Signature of applicant Address of applicant (number and street city.state,and ZIP code)
0-��, �cD� x f;o/ 333 hIA-a i-oi .07
Signature of auth ed re resen tive / Address of aut onzed representative (number and street,city,state,and ZIP code)