HomeMy WebLinkAboutAge_Williams e r,,o APPLICATION FOR SENIOR CITIZEN CO - fg ( 0 • v ' pa, YEAR
PROPERTY TAX BENEFITS . al;...*asti State Form 43708(R13/4-15)
\ Prescribed by the Department of Local Government Financ
i t • Fl
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. y/,�j�1
INSTRUCTIONS:To be tiled in person or by mail with the County Auditor of the county where the property is locatte fbSON COUNTY AUDITOR
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
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)
Over 65 Deduction from Assessed Valuation
Do all joint tenants or tenants in common reside on the properly?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying 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 tl• 'rid Key number/Legal description I Record number Page number
44,-l8. 36 -3ao - 00A.0/ 7-o.t,y
Does applicant reside on property? Av.-sassed value of the property as of current year assessment date(may not exceed
$162,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
CI 65 Circuit Breaker Credit.)
IS Yes 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?
CY,Yes ❑ No 4. J
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes N No
INJe 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) if vhs.i. /r
ik S Gr1..,,, �/03�'cf 5 ? .1,51-cA 0Nr/y Haw `f763 -
Signature of authorized representative Address of authorized repr sentative (number and street,city,stale.and ZIP code)