HomeMy WebLinkAboutAge_Reed a ".. APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP I YEAR
},.? PROPERTY TAX BENEFITS FILED
r. State Form 43708(R10/12-08)
�'.ii Prescribed by the Department 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. APR 2-5 d
INSTRUCTIONS: n/
To be filed in person or by mail with the County Auditor of the county where the property is located. �(�'IfAy
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deo9J?a QV)c/NIX.AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During 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 check all that apply)
X Over 65 Deduction from Assessed Valuation 'Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
is al),(cIAVIr
p 4 /3 /J
Is ap cant the sole legal or eq owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
El Yes 9 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(I)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
TaT strict Key number I Legal description Record number Page number
li> 2(0 l > 03 - ycO o0 /. G ) - odd
Is the property used and occupied pri rily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residence? 25 -Yes for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ No
Was the applicant 65 years of age or more on December 1 of the year
Have you filed for any other deductions? If Yes,what deductions?
,l Yes ❑ No /1 5
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes i 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 Ij
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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