HomeMy WebLinkAboutAge_Hensley APPLICATION FOR SENIOR CITIZEN cowry TOWNSHIP I YEAR
a _ ,:1 1� PROPERTY TAX BENEFITS
Stets Farm by the apart 0.i 7) tCYI
� O\91'(p 'cat`
Information contained in this document Is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark
i
INSTRUCTIONS: To be Ned In person or by mall with the County Auditor of the county where the property Is located.
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 mat property:During the twelve(12)months
before March 31 of the year the deduction Is to be effective
See reverse side for additional instruction and qualifications.
Type of benefit requested(Neese
cher. etl that Apply)
rover 65 Deduction from Assessed Valuation s uit Breaker Credit
Name cif applicant(owner or contract buyer)
len51ey
Is epptiard the ads legal or equable owner? If No,whats share or . B tamed with;rent tenant or tenant In common.i dicab with whom.
es ❑No DEC 2 8 2 18
II name on record Is different than that of applicant.Indicate below. Do all joint lerants or tenants hi common reside on the ❑No
Name of contract seller a order rem,,dedd.Dyad far
deduction?
OD wires 0 No
seller
Address of contract (manlier and street,city,state,and LP code) (steS Is thepdope property in
SCal property 0 Mobile tome(IC 6-I.1-?)
TarloistrIct Key number I Legal description Record number Page rnunber
t1Yvu•&\\C-- a,l, — I9-— la- ao 4 - coo-436- o lx
Does apppmnt reside on property?es Assessed value of the property as of rent year assessment date(
Is the applicant 65 years of age or more an December 3:tof the year
-• Amount of Income
end joint tenanb or tenants In common,as applicable(For Over 65 DeducSon,
AG:may not exceed S25,000;for the Over 65 Gina*Smoker Cred3.AGl may not ` o - $
exceed 530,000 brbndviduals or$40,000 form girded couples j.
See raven for detans. I s
TOTAL S
Have you filed for any other deductions? d Yes,what deductka'a?? L,-
,.,I '/1
Pirec ❑No Hone ) /7lbl4gojei
Have you feed far deductions In any other�"�7 It Yes,what can*?
J J
Dyes [fnio
IMIe certify under penalty of perjury that the above and foregoing information Is true and correct.
Signature
^,off inca tom+ (,(��-'�� �fy je/, ' Data(month.day,year)
Address a epeecmdAnumberand iUly,� �. FIR cod!)
(- ST'J'r
Ole E€ Wa(nl t , l)�ehSU+/� , `� 66S
Signature of authorized representative Data(month day,year)
Address of authorized representative (number and sheet.city.state,and DP code)
Signature of�tr1/w P for ekk\S� C (cam l °�°"`2=r2-4S — \ '
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer