Age_Woodruff� APPLICATION FOR SENIOR CITIZEN I couNn � TOWNSHIP � YEAR
, PROPERTY TAX BENEFITS I� �` �
��'� .. ''� Stam Fortn d3708 (R9l 40B) o
Prescnbad Dy tha DeDanment of Local Govemmem Financa JL
File Mark
Informatiom m�tained in this tlowment is CONFIDENTIAL Wrsuant to IC 6-1.1-12-9 and IC 6-1.7-35-9. � E C 2 9 Z��$
INSTRUCTIONS:
To be filed in person or 6y meil with the CountyAudifo� o/ the coun y where tAe property is located. ���
Filing Detes: i) Real Pioperty: Dunnq the tweNe (72) months be/ore December 37 olthe year the tletlucfion is to e e e�re. �1'
2/ Mobile Homes assessed under IC 6-1.7-7 or manulactuietl homes not assessed as real pr�$�qQ�iirV`n���Ti%Iv�7{�JTi�ii ths
�
!1
be(ore March 31 0/ the yeer fhe deduction is to be ellective.
See reverse side for atlddional insWCtions e�M Qualifications.
Type of heneH �epuested oaso rheck e0 fhaf app1�
Over 65 Deduclion 6om Assessed Valuation �Over 65 Circuit Breaker Credit
Name of diranf (awnor a cmtmcf D Q
�� � �
I5 apPlimrit thB SOIe leqal or apu�aWa OwneR II No, what i9 hiSRfe� exad share or i:�tetas�? If owned vn�h someone otha� �han spouse.
indifale wi�� wnom
❑ Yes ❑ No �
If name on racortf is diflarent Uan ihat of a��licant, iMicata bebw
Name of coniracl satler (apWicant mvst haw Doen Duyirp m cmtrad at Mast ora (1J yea�
Pdd`ess W wntratl seller (numOw aM sbcot. crty, sbfi, and ZIPmOe) I Is ine omoerry in cueslion:
� Real property � Mobile home (IC 64J-�
T�ing ai ct Key numbar / Legal dascnDtirn I Racord numher Page numear
a��-� �1�-la-a 9-Yoo-oov.79�;oa7
Is lhe propeM used and oauDied o���N br Assessea valve of the o:coerty as of Marcn 1, cur.er.t yexr (may not crcactl 5fB1,a30
hismar residenm7 :or Owr 65 tletluctiw,, w 5160.000 tor Ihe Ove/ 65 Circui! 8roaker Ciotlif)
� Yes ❑ No
Was �he apWicam 65 years ot ege or mwe on December 31 ot tha year �.
Have you filed tor any other tleducGOn57 iF Yes. w�nat aedvctiors?
es � No �- ��ti7�
Mave }rou filed for deductions in any other cwnry0 If Yes, wnat county?
❑ Yes ❑ No '
IIWe certify under penalty of perjury that the above and foregoing information is true and correct and lhai the applicant was a resident
of Indiana and owner of the aforementionad property on March 1, 20
Signature ot eDO�ran Pdtlress of aoolicar.t (numberantl street, ci,y, sa:e. antl21P mtle)
/3�0 �3So S -� � . �/767�
Sipnature of authonzed rao�esantativa Adtlress ot autnwizeC rewesentative (numberarb s:reet, ciry, sta�q antl LP codo)
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