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APPLICATION FOR SENIOR CITIZEN
_-^ '� PROPERTYTAXBENEFITS
; ' j Spte Fwm 43708 (R9l 9-08)
Presuibed by ihe �epartmant of Loral Go�emmeM Fina�e
� � TOWNSHIP YEAR
�pR 2 - Fle Mark
Informaliom m�tained in this davment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC G7.1- �
INSTRUCTIONS: C �'��\�
To 6e fded in person orby mail wiflt the CourrtyAud"Aoro7the county where fhe property is located. v
vpt,DITOR
Filing Dates: 1J Real Property:O�nng the twehre (72) mmtlis 6efae Decem6er 37 o/th��0�1c6i�}1 Q�A to be eRec(irve.
2J Mobrle Homes assessed undei IC b1.7-7 ormanulaGUred hanes rwt assessed as real property: Durirg fhe ArsNe (72) months
be/ore Marrh 37 of Ihe yeer the tletluction is lo be eRective.
See reverse side (w adtlitional inshudions end qualifications.
Type of banefi repuesled (please rheck aH Naf appy)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name af appfwaM (amor w caitract bvye�
nd4 a�r�
Is appGant the sda lepal or equtaWe owneR If N0. �� hisThar share w irrterest9 If wmed vnth mmeone other ihan spousa.
ir�dimte with whom
Yes ❑ No
H nama on recortl is diflaren n that af applicant, indicate belaw
Name of contaG aAer (appficanf must have 6een buyug m cmlract af laasf orre (1) yeaQ
Address d mn f] mller (numberaM sbeoL �+�Y, stale, a�M LP wtle) Is ihe pmperty in quesiion:
eal property � Mobile home QC 61-7-n
Taz' dist(iG Key number I Legal descriplion Record num6er Page number
a G-�,-� q-aod -ocy. ao� -oa�
Is th pmperry uSeE ntl ocwpied pmm �l tor Assessed valua o( Iha pfo0erry as of March 1, wrtertl year (may rwt srceed 5782,�30
hisRier resiAence7 !or Oeer 65 dotludini, or f760.000 /or No Over 65 Circ�it &ealmr CredrQ
�s ❑ No
Was Ne appGraM 65 years o! age or mora on December 31 of the yaar
Have you fileE fw arry other tledu�ons7 If T§s, what deductions7
� YBS O
Hava you filed far deductions in aiy other courityl If Vas. what counry?
� Y25
IIWe certify under penalty of perjury that the above and foregoing infortnation is W e and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of appfirant Pddress of appGram (numneraM strcret dry, s7ate, aM LP wdo)
� �� y� -� s� /�s ��i ,% . �
Sig tureo(authw¢ reprasamative Addressafauthorimdrepresentalive(numEaanCSfreet,city,5tafe,andLPCada) f�'�/ s
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