Age_Mason (3) APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR I
y_; '? PROPERTY TAX BENEFITS
- -• State Form 43708(R9/9-08)
rile / Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: L t ' ,D
To be filed in person or by mad with the CoAuditor of the county where the property is located. I 1J
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective. ow2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real propertAtQlpnath3t W/012)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. /1
72
Type of 5enefl requested(please dock all that apply) 10 N
1BSON COUNTY
L2�er 65 Deduction from Assessed Valuation U Over 65 Circuit reaker Credit
Name of applicant(owner ar contract buyer) AUDITOR
iv,,,,,rk n- ci Jane. 149 oasok-,
Is applicant the sole legal or eCuitabte owner? It No.what is hisfner exact share or interest? If owned with someone other than spouse.
/ indicate with whom
❑t -i ❑ No
It name on record is d.'ferent than that of apoticant,indicate below
Name of contract speller( ant must have boon buying on contract at toast ono(1)year)
t1 v r+
Address of contract sane (number and street city,state.and ZIP code) Is the prooerty in question:
❑ Real properly ❑ Mobile home(IC 6-1-1-7)
Taxing d • I Key number I Legal description /-� Record number Page number
COOL a_ Ia(Q - «-1 0i-C°(- °-7
l II
Is the property used and occupied prima* Assessed value of the property as of March 1,current year(may not exceed$182.430
hiss/her residence? for Over 65 deduction,or f 160.000 for trio Ovor 65 Circuit Breaker Credit)
EYes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
prior to tie current yea(?
MYes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership(For Over 65 deduction,income
may not exceed 525,000;for the Over 65 Circuit Breaker Credit,
income may not exceed S30,000 for individuals, or S40,000 for
marred couples).
Have you filed for any other deductions? If ems.what deductions?
❑ Yes Nt No
Have you filed for deductions in any other county? It 14s,what county?
❑ Yes 4 No
I/We certify 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
Signature cf applicant Address of applicant (number and stroot,city.state,and ZIP code)P R/yC ET0i✓li✓.
_ /`''�;v11 // � 505 W/9Uo/U P?i4iPR, 1-7/ 7 7 D
Sphatura authorized representable Address of authorized representative (number and strop(city,slate.and ZIP code) 1
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