Age_KoenigAPPLICATION FOR SENIOR CITIZEN
�. - PROPERTY TAX BENEFITS
(� f State Fwm a3708 (R9I9-OB)
PeescnbeC by Na DeDartmem ol Local Govemment Firanca
Infwmatiom m�[aineE in this tloament is CONFIDENTIAL Wrsuant to IC 6-1.1-12-9 and IC 6-1J35-9.
INSTRUCT/0N5:
COUNN TOWNSHIP � YEAR j
I
DEC 1 1 2008
To 6e filed in person or 6y mail wdh fhe CountyAutlitor olthe counry where the property is locatetl.
Filing Datas: 7) Real PropeRy: Dunrg fAe fweNe (12) months before Decem6er 31 o/fhe year fbe deduction is to 6e eflecfnre�%G`�. ��
2) Mobile Hanes assessed undei IC 6-7.1-7 oi manWactured homes not assessed as real pmper(y: Dun fhe fweNe Gf'2) mont i
belora Merch 37 o/fhe year the deduction is to be eflective. �SON COUNTY AUDITOR
See reverse side la addifional insWGions arM Oualifications.
Type N benefil re�ueSeE (p/ e rhock ep that epply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name ot applifant ( er or cmtract G�yoQ
Is a�olifarrt the sole legal or eQUi�aWa ovmeR If No, whai i9 his/her ct sha:e or ir.te:est? If owned vnth someone other Ihan soouse.
iMitata with whom
❑ Yes ❑ No
tt name m rernrd fs tlitfarant Nan lhat W aoo���l indiwte bebw
Nxme of mni2d se7er (appllcant must fuw bom buying on cantraa at least orm (1) yea�
� Pddress W contrad saller (number aM street, crry, stafo. arW ZIPwOe) I �s ine omparry in cues�ion:
� Real propery � Mobila home (IC 6-1-1-7)
g distncl Key number I Legal descnotion Reco�d numSer Page numcer
�- a� - I�a- �oo-o�. �a��oa�
Is Ne proparty use� and uped pnmaNy kr hssessed value of tbe O�oerty as of Ma¢h i, curtert year (may nof excoetl 51H2.a30
hisRier re5idenca4 tor O�er 65 deduc(ion, w 5;60.000 IorMO Ovcr 65 C'ucuit &oaker Credi�
� Yes ❑ No
VJas lhe apolicam 65 years of ege or more on Decembar 31 of the year Acol�nfs da�e of birth (month, tivy, yoar) If filed by a survivir.g, unmamed spouse,
onorto Na wrrant yeaR what was ihe spouse's age ai ihe time
� YB5 � No otdeam?
Adjusted gross income of applicant, spouse, and any �
Have you fiiad for any Whar deCuctions? �f `bs. �.r:^at ceauctior.s?
� Yes � No
Have you fiied fm dedudions in any other camry0 If `.?s, x:hat wur.ty?
❑ Yes ❑ No
I/We certi(y under penalty of perjury that the 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
�$ignature of a rant Address of a�olimr.t (r.umberar.� svicet. ciy. sta:e. and ZIP mtlo)
so � 350 � �� �6?v
atura ol authonzed raoresentative ACdrass of autnorizec :eaasertative (nombe�antl slmot. ciry, slata, and ZIP cotla)