HomeMy WebLinkAboutAge_Kohlmeyer ..frtr., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
°s ` PROPERTY TAX BENEFITS
5.. %' State Form 43708(R14 110-17)
Prescribed by the Department of Local Government Finance {. !s_
FileTa ' Ift
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. D [+
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. A Pn o 2018
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the follow(�i.'=nuary
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property: $U 1t1.! `�"'11,1 s
before March 31 of the year the deduction is to be effective. U COUNTY q(JOITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply.)
®Over 65 Deduction from Assessed Valuation 'h4 Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyed !/
James Lee Kohlmeyer
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
WI 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?
ID 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 th roperty in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxin ,rid Ke number/Legal description Record number Page number
Ada .762-4( plea-ado. Af,1"—ooh 8
Does applicant reside on property? Assessed value of the property as of wren year assessment date(May not exceed$182.430 for Over 65 Deduction or$759,999
I73 Yes El No (counting just the homestead site)for the Over 65 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?
Dyes 0 N
Have you filed for deductions in any other county? If Yes,what county?
❑Yes QI No
IANe certify under penalty of perjury that the above and foregoing information is true and correct.
Signs . e of applicant ^ , Date(month,day,year)
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Add s of applicant (number and treet,city, . :• ` /he) /
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Signature of authorized repro entative I Date(month,day year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor I Date(month,day,year)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer