Age_Neufelder" APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
Stab Form a3708 (R9! 9-08)
���•� � Prescnbad by Me DepartmeM ot Local Go�emment Finance
Infwmetiom m�teined in this dowment is CONFIDENTIAL pursuant to IC 61.1-12-9 and IC 6-1.1-35-9.
COUNTY TOWNSHIP YEAR
i e ar
APR 2 3 Z010
INSTRUCTIONS:
To be filed in person or 6y mail wifh the CountyAUtlifor o/ the wun(y where the property is locafed.
Filing Dates: 7) Real P�operty: Dunng the fweNe (12) monfhs befae December 37 0( fhe ysar the deduction is fo be efl �
2) Mobile Hwnes assessed uMer IC & f. t-7 or manuladured homes rrot assessed as real propert7��� t� �1A R
6e/ae Marrh 31 of fhe yeer the deduction is to be e//ective.
See reverse sitle lw eCddional insWdions a� pualificaUons.
TYPa d bafrefit faauesie0 eese Meck a0 Natapp/y) .
�Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name d apd��(1 _(ovnrer u' canhect OyeQ�
1... T
Is ap0limrit the sde lapal o� epui�aMe owneR 11 No, what b isfiar exad shara w inte�est? If wmed vdih someone other Ihan spouse.
inditate with whom
oY� ❑No
tt name on racortf ia diflarem than Nat of apdiran4 indicete bebw
Name of mntrad seAer (applicenf mtttt have beon Ouyirg on can4ad af basf orre (1) yeaQ
Pdtlrass ol contratl seVer (nwnbar aid sbeeG tiry. sbfe. antl ZIP oode) Is tna o�oerty in ouestion:
,�Real property � Mobile home QC 6-7-7-�
� Taxing distnct � Key num6er / Leyal descnption Record number Pa9a r.um�e;
C,(�,c,�n� -/8-13•�103-0o0,76z-O s
Is Ihe pmpeM1y used and occupiad Dnmariy br Assessed value of �he O�oerty as of March 1, curtent year (may nol exceeC S1H2,d30
ttis/ner rasl0ence4 lorO�er 65 dodud'an, a f f 60.000 for Ne Over 65 Cilcuif &oaker Credi�
� Yes ❑ No
Was the appfi�M 65 yeare of aBe or mora on December 31 oi the year
Have you filed for erry other deductions7 �f Yus. what deduNOns?
�Yes � No 1-�' �
Nave you filed for OeOuctions in eny other cwmy? If 19s. what courrty?
❑ Yes ❑ No
IIWe certify under penaly of perjury that ihe above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
se�amreaavW�m Mtlrass epplirant (num0ereiMsboat,ciry,sWte,a�MZlPwde)
�/07 � o �
Sipnature of euNorized'aD�eseMativ a of authwizad o�esa tive (numDer aM s✓ee4 dry, 51are, antl LPcrode)
�o F �N .
�f 7� ��