HomeMy WebLinkAboutAge_McClellan °' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
\ S PROPERTY TAX BENEFITS
S 6 r State Form 43708(R13/4-15)
Prescribed by the Department of Local Government Finance a--
( File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-g. -V�
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INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property iss llooccat�(�I.t J 20 8
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postrha4 g d bythe following nuary 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Durir t rl elve(12)months
before March 31 of the year the deduction is to be effective. C tort OR
See reverse side for additional instructions and qualifications. N OUN fY A
GIBS°
Type of benefit requested(please eck all that apply)
[,l ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) n
9/Cyttefi .Is applicant the sole legal or eq able own If No,what is hi m r exact share If owned with joint tenant or tenant in common,
indicate with whom
(1 Yes 0 N
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 Has applicant owned or been buying the property under recorded
contract for at least one(I)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
a6 / ) $ - yob - opt. alga
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
❑ No 65 Circuit Breaker Credit.)
Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes U No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
Ii 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)
Signature of aut 1'zed re•rsen- ve Address of authorized representative (number and street,city,state,and ZIP code)