HomeMy WebLinkAboutAge_Padgett ail APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�__. PROPERTY TAX BENEFITS
y(� /' State Form 43708(R13/5-15)
\\.,:� Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be filed in person or by mail 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-I.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. LW
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Type of benefit requested(please check all that apply) ��•J�
El7Ocer 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Brea-FILED
If owned with joint tenant or tenant i corn n,
indicate with who
CC ❑ No not C(�'{p1Tv AUDITOR
It name on record is different than that of applicant,indicate below Do all joint tenant3t8 ML6rrSi-monnrreside on the property?
Ltd'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:
U Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number I Legal description Record number Page number
-'-4NGSCn aksii- 1--1-3o - DCo .a28r COS
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
l--l// S 182,430for Over 65 Deduction or S159,999(counting just the homestead site]for the Over
L� Yes ❑ No 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day year) If filed by a surviving,unmarried spouse,what
prior to the year taxes are first due and payable? � was the spouse's age at the time of death?
R Yes ❑ No
Adjusted gross Income of applicant,applicant and spouse, or
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
IMe 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)
zart-te ! �� 30 6 e WO o p s r .
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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