Age_Caldemeyer❑
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APPLICATION FOR SENIOR CITIZEN courrrr TOWNSHIP rEnrc
_- _ PROPERTY TAX BENEFITS
S-''• State Fortn 43708 (R9l 9-0B)
Prescnbed try ihe Departmer�t ot Local GovemmeM Flna�e
IMormatiom m�tained in lhis doament is CONFIDENTL4L pursuant to IC 6-1.1-12-9 and IC 61.1359. y1 �� � N �1 I�
a� n u I�
INSTRUCTIONS: Y ,�/
To be filed in person or by mail with the CountyAUtlrfor o! the counry whera fhe property is located. '(�
Filing Dates: 1J Real Property: Dunng the tweNe (12) mmths befae Decem6er 37 o/fhe yearthe tletluction �@`�e �,flecli���
2J Mobile Homes assessetl untler IC 6-1. 7-7 or manu/adured homes nof assessed as real property: Durng fhe hre.
belore Martfi 37 of fhe year the deduction is lo be eflec6ve. C�'� ��
See reverse side foradditional insWdions and qualifications. �
Typa o( banaH reQuesied (ploasa eck aH Ihat aPNYI GIBSO
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credil
(awner ar cartraG buYe9
app6rdM�epal or equitaGa�"'� R If No, what is hisrtier axad share w irrtarast?
L�-j�Yes ❑ No
`ame on ramrd is tliRarent Ihan Ihal af apd��l indicate below
.'^�I
AAtlress d mntratl saller (nwnDe aritl sbaeL
Tazing district
Diryirx� m cm7acf at Ma5 orre (il yeah
Key numbar / Legal
�'l�'�—"l �I I. 5Y� -O�c�
Ls Ihe P��rtY used aM oauWeE Wimar�' br
his,her `aSiOanm?
es ❑ No
VJas iha appfram 65 years of age w more on Dacember 31 of lhe year
priot to Na airterit yeaR
� Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not ezceed 525,000; for fhe Over 65 Circuit Breaker Credif,
income may nof exceed $30,000 Ior individuals, or 540,000 fw
married couples).
Mave you ked for any olhar deEuctions7
� Yes
Have yau filed tor dedudions in any other caunry7
❑ Yes
� No
❑ No
Is �ha
a�ssad �awe or ma y�
!o� O�er 65 tledurlion, a�
If ovmed vrtth mmeana
irMimte with whom
(72) monfis
1
Real pmperty � Mo6ile homa (IC fr7-1-�
mrd num6ar Page number
I/We certify under penalty of perjury that the above and foregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
7naty,aotagpll�frt AddressotaPP�M (�baieM56eeL�;sbb.eMZlPwde)
Address of auttror'rmd rep`esentative (nvnber aM stree4 Wl: �tq entl LP wde)