HomeMy WebLinkAboutAge_Hensley 177---°{ APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR
b— - PROPERTY TAX BENEFITS y �T
• r/ State Form 43708(R13/4-15) �Hj AL)
we Prescribed by the Department of Local Govemment Finance ■g 2 ,(
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. FEB 2 3 F,(I�.,Mark
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located. i (U.i
q 7q►.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked d b t� r.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as rearprcpellI •u ng thet twelve(r (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 ck all that apply)
P Over 65 Deduction from Assessed Valuationer 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the sole legal unable owner? If No,• is his/her exact share or interest? If owned joint tenant or tenant in common,
indicate te wiwith h whom
esCs ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Hasa applicant owned or been buying
pt f r bf the property under recorded
contract for at least one(1)year before claiming deduction?
❑ Yes ❑ No
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)
Taxing district Key number/Legal description Record number Page number
6-� 3 -0r DOD COD ig cs-ccA
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
5182,430 for Over 65 Deduction or 5159,999(counting just the homestead site)for the Over
ID Yes ❑ No See Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes 0 N
Have you filed 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.
Signature of applicant Address of applicant (number and street,city,state.and ZIP code)
5-D 3 s 9 Q/Le /4 of llr o u116 3,
Si a re of authorized repre tative Address of authorized representative (number and street,city,state,and ZIP code)