Age_Weber (3)� APPLICATION FOR SENIOR CITIZEN
4 PROPERTY TAX BENEFITS
` —' State Form 43708 (R9l 9-08)
� P�escribed by the DeoartmeM of Local Govemmem Finance
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Infwmatbn wntainad in this tloament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.135-9.
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INSTRUCTIONS: �� ��
To bel/ed in persm or by mail with fhe CountyAudita o/tAe county where the property is locatetl.
Filing Dates: 1) Real Property: Dunng the tweNe (12) months belore Decem6ar 37 o7fhe year fhe ded�c�196Q?M�1q� AUDITOR
2J Mobile Hanes assessed urMer IC 6-1.1-7 ormanufacturetl homes rrot assessed as real property: Dunrg the tweAre (72) months
be/ae Merti� 37 o7the year tAe deduction isYo be e/fective.
See reverse side lw adUifional insWdions arM qualifications.
Typa d beneft repuested (please diock aB fhaf appiy)
�Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Namedapo�rcarit(owrrera Duye�
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Is epplitant he sole lepal or eQUitaWe owna/I If Na, what is hisRier ezacl share w intaeasl9 tl owned vAth mmeone other lhan spouse.
indifate wit� whom
❑ Yes ❑ No
M name on recorti is di.Tarem dwn tlwt of a00frcanl indicete 6ebw
Name M conirza sei�er (app'rcant must have bean ouying on cantrau et roast orre (f) yeah
Pddrass of contrad w�er (nwnba aM abeeG ctly. sbte, and 21P wEe) Is Ihe proDerty in puesCron:
�Real D�GertY ❑ Mobile home (IC &7-7-�
T�inp Eisinct Key number / lagal descnption Recortl numbar Page numbar
�.��r-- -l9-0�; 300 00/. �03_o a
Is Ne property used and accupiad pnmariN �r 0.ssauetl value ot lhe Droverty as ol Mamh 1, wrter.t yaar (may nol erceed 5182,a30
hislner resi0ence7 hr O�er 65 tleducfim, a f760.000 hr Ne Ovcr 65 Lircuif Broaker CreOi�
�Yes ❑ No
Waa the appficaM 65 years ot aBe or more on December 31 W the year
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r+a�e yw rdaa ro� em anar eee�,av ir �. �� ded�a;oti?
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Hava you filed fw deduc6ons in any other munry? If 1§s. what wunry7
� Yes ❑ No "
IIVJe certify under penalty of perjury that Ihe above and foregoing information is true and correct and that the applicant was a resident
o( Indiana and owner of the aforementioned property on March 1, 20 �
Spneture W appfKaM Pddress of aoP�icarl (numDar antl sbee4 ciy, 5late, antl Z/P wde)
n � x �a�� J. ,��E �� ��.,�, ����r�.
Sign re ot auNOnzed raD�esentaGve Address of aulhorized ra0resentative (numberarM stroot, ciry, sfafc, and ZIP codo)