Age_Robison^`n II� � COUNTY TOWNSHIP YEAR
o APPLICATION POR SENIOR CITIZEN �� ��
PROPERTY TAX BENEFITS
Sta�e Form 43708 (R9 / 9-OB) ' /1
•O � Prascribed by �ha Depanment of Loral Go�emmaM Fina � �
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Information wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC 6.1 9. APR ��'�12
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INSTRUCTIONS: C . �J. n�
To be filetl in persm or by mail with the CountyAuditor ol the county wheie fAe p�operty is localed. �
Filing Dafes: 1J Real Property: Dunng (he hveNe (12) months belore Decem6er 31 ollhe ysar the deduction is����'qbUNTYl4UDIT�OR
2) Mo6ile Hanes assessed urMer IC b7J-7 or manWac[ured hanes rrot assessed as reel pmperty: Dutirg Ihe hveNe ( 2) mon s
belora March 31 0l the year the deduc8�on is fo 6e eflecfive.
See reverse side fw additional insLUCtlons and qualifications.
Type o( henefi raQuested (please rheck aH Ual aPply)
Over 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
Name of appr (awrrer or confraU buyorJ �
U '�--/
Is applimM lhe sda legal or eQuitable ownaY! If No, what is hislher exad shata w in�erest7 If avned wiih someone oiher than spouse,
indimte wi�h whom
❑ Yes ❑ No
It name on remrd "a diRarent �han tlial o( a0d��t ��dicate bebw
Name of mntrarl seller (appficant mvst haw boen buyiig m canfract at bast orw (1J yea�J
Pddrass o( mntrad seller (rn�m6eiaM street, ciy, sfate, erW LP wd¢) Is Ihe pmperty in Question:
� Real pmperty � Mobile home (IC 6-7-0-�
Tazing d�stricl Kay number I Lapal descno��+ RecoN number Paga number
�D� - /� /�-o� a-UUO. �/dn- Oo�-7
Ls Iha properry usaE anE ompied pimanly br hssessed valua ot Na pope�ty as of Maml� 1, wrtan� year (may nat arcaeC SiB2,430
hi4her rasitlence7 fw Orer 65 tle0adion, � f160.000/or Na Over 65 Cirtruf &ealmr Gedi�
❑ Yes ❑ No
VJas ihe appGmrit fi5 years of ape or mae on Oecembar 31 d Ne year
Have yw filetl for arry olher deduc�ons7 H 14s. whal daE�dions7
� Yes ❑ No
Mave yau fled far deductions in any other munry7 111§s, what cauMy4
� Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing infortnalion is true and wrtecl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
'gnatura ot apq'rartl Addrass of appfranl (mmber aM sboet, rily. sFafe, aM ZIP mde)
c: �O�% `�' �/r/c �/lii ` d �/� D
Signature of authwized re0�eritative Pddress of aufhor'aad repewntativa (numDera�stmef, city, 4ate, and LP catla)