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, 1""'�. APPLICATION FOR SENIOR CITIZEN I couNn � TOWNSHIP � YEAR i
PROPERTY TAX BENEFITS I
Stare Form d3�08 (R9 / 9-0e)
� S�u � Prescnbed by ihe DeDanmem of Local Govemmem Finaoca
ile M
IMormatiom m�Winad in this tlowment is CONPIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
wsrRUCnoNS: 3 0 2008
To 6e filed in persm or by mail wdh fhe CountyAUditor ol the county where the pioperry is located. � E�
Filing Dates: 1) Real Property: Dun� the AveNe (12) months belore Decem6er 31 o/fhe ysar the deducfion is to be eHective.
2J Mobile Hanes assessed under IC 64.7-7 o�manulacfured homes rrot assessed as real property: DunngtlleRweµ fyi�'L�ths
�/ �l 1
before March 37 0/ the year the deduction is to be eNecfive. �J �
SeereversesMelaadddionalinstructionsandqua�ificaGons. rjISSON COUNYY AUBIfit�
C�
Typa of beneft `epua5 (pleaso Mack a� Ihat apply� /
Over 65 Deduction from Assessed Valuation ��
Name of e m( a cmvact Duye�
ax�.Pd� f �o 5��.-�
Is a0����1 lhe ada legal or eCUitable ownerl It No, what is nisfner exaa share or ir.terestl
� Yes ❑ No I
If nama on (ewrE is difteant than Ihat of aoo��ca�t indiwte 6elaw
Name ot mntae saller (apdicant musf ha�e becn buying m cmtract at bast ono (f) ycarJ
Address of mntrad
aM s✓cet, cify, sato, and ZIP code)
- /%a
Is Lhe [moaM ���arM occuDied pnr/any br
hisfier rBSidenc�' l /
\./
� Yes ❑ No
Was the appiicaM 65 yeers of aga or mwe on Oecember 31 d the year
pnor to ihe aurem yea(7
� Yes ❑ No
Adjusted gross income of applican; spouse, and any
individuals sharing ownership (FOr Over 65 deduction, income
may not exceed 525, 000; lor the Over 65 Cirwit B2ake� Credit,
income may not exceed 530,000 for individuals, or 540, 000 for
married couples).
Nava yau filed (or a�ry olher deCUUions7
� Yes
Hava }rou filed Iw Eeductions in any other counry7
❑ Yes
� No
� No
65 Circuit Breaker Credit
- 60/,
0.ssessed value ot tne o:�
fo� O�er 65 dotlucfion. or
If ownetl
indimta
the oroperty in Question:
I/We certify under penaity of perj�ry that lhe above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
prqture W a iranf �., drass of ap0�irart (numGer antl swN, ciry, state. and ZIP coEe)
vr✓r
• Signatura of
of
and sheet, ciry, 5ate. and ZIP co0c)
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