Age_Karges (3)APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
� ` .. ' Smre Fmm 43708 (R9 / 9-OB)
Prasai6ed by the DepaMnent of Local Govemmeril Financa
Information containetl in this tlocvment is CONFIDENTIAL pursuani to IC 6-1.1-12-9 and IC G1.1-35-9.
`❑
COUNTY O N HI � YEAR
Fi Fj1�k2 C�IU �
WSTRUCTIONS: �
To be Fled in person or by mail with Ure CountyAUditor o/ fhe munty where the property is locafed. . G�BG f1�� ��i,�
Filing Dates: 1J Real Property: Dunrg the fweNe (12) morrths belore December 31 o/fhe year the tleduction is to be eBecti�U.• CQU y 0�
2J Mobile Hanes assessed under IC 6-f. 7-7 or manulacfured homes rrof assessed es reel proOeM' Dunng the tws/ve (72 m�ii:AB1iDA,
6e%ra Marcfi 37 07 fhe year tAe tleducLOn is to 6e eflective.
See reverse side /w atltlilional insWdions and qualifications.
Type N baneH reuuesie0 eeso Mxk e0 fhaf apply)
Over 65 Deduction from Assessed Valuation
Nama of apo��M (� u' carfiad OuyeQ//
// � � F // n _,. n�m �
U aQGJiEam tha sole lepal or aquitable ayngR If No,
v �/
❑ Yes ❑ No
If name on racord ia diflatent than ihel o( eod'wan( iMicale beWw
Nama of cmi2d sellar (appGcanf must Aare been dryinp on cm'uact af leas( orre (7) yoa�
Adtlress W mntrad eeller (numbw aM sboet rJty, sfafe,
Is Yi� property used aM ottuped
hi�/nbr rasiEence7
Over 65 Circuit Breaker Credit
H owned �rth swneone other than sOwse.
indidte vnth whom
Is ihe p`ooa`ty in duestion:
' — — /J' C.CLJ ...1 / 7�,
Keynumber/Legaldescnption —�
a
br I Assess val • otlhe prt
/or Owr educfim, ar
❑ Yes ❑ No
VPaa the appfaarM1 65 yeare of age w mwe on December 37 of lhe year
D�Of t01he alfiBM y88/1
� Yes ❑ No
Adjusted gross income of applieant, spouse, and any
individuals sharing ownership (For Over 65 deduction, income
may not exceed 825,000; for the Over 65 Circuit Breaker Credit,
income may nof exceed 330,000 /or individuals, or 540,000 /or
mairied couplesj.
Have you filed for erry dher deducEOne9
Mave you fJed fw deductions in eny other
� Yes � No
� Yes ❑ No
Real property � Mobile hwne (IC 6-74-�
number � Page r.umber
�
I/We certify under penalty of perjury lhat the above and foregoing information is Irue and conect and lhat the applicant was a residenl
of Indiana and owne� of tha aforementioned property on March 1, 20
%appficam Addeasaofa001rcart (nwnEmaMsbeetciry.stafe.a�ZlPwde)
� � k��.�r � � ��� � q s� �d � ��� ./�'i��r ,
of auN � aE reores taUve �Address al authorized raoresentative (numbw arW st2eL ciry, stafe. and ZIP cotlo)