HomeMy WebLinkAboutAge_Rodriguez S a—:,7 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a� - i PROPERTY TAX BENEFITS
7.� �'� 1
' State Form 43708(R13/4-15) C`, � �� 1
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refs. Prescribed by the Department of Local Government Finance
•
Filing Dates: 1) Real Property:Form must be completed and signedby December 31 and file. ."postmarked by the foil.,'•_.aanuary 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not asses.ed p• - property: f•uring the twe/ge(12)months
before March 31 of the year the deduction is to be effective. ' \ ,
See reverse side for additional instructions and qualifications. ell...... I
• Type of bene le e check all that apply) ( 1
Over 6 eduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
N f appli nt(owner or ntracf buy
Q '
Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
FILED Yes ❑ No
Name of contract seller Has applicant owned or been bu ` g t property under recorded
contract for at least one(1)year•efore laiming deduction?
DEC 062019 ❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the rop rty in question:
�RCr1 (l r Real property CI Mobile home(IC 6-1-1-7)
Taxing district Ke Urhb�Y/ Igj,j 1iyn AUDITOR cord number Page number
CZ6 `2_ 1 `g -fie 2 —O0 Li .2‘ 1"- - )2:9--
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting just the homestead site]for the Over
Aes ❑ No 65 Circuit Breaker Credit.)
❑ Yes ANo
IMIe certify under penalty of perjury that the above and foregoing information is true and correct.
(111k))cignature of applicant Address of applicant (number and street,city state,and ZIP code)
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'gnature of autho' representative Address of authorized representative (number and street,city,state,and ZIP code)
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