Age_Dike"' APPUCATION FOR SENIOR CITIZEN
, PROPERTY TAX BENEFITS
• ` ' Stab Form 43708 (R9 / 9-08) .
Prescnbed by �he DeoaNmaril of Lo�'al GoeammeM Fina�e
Intormation wntained In Mis tlocvment is CONFIDEN7IAL pursuant to IC 6-1.1-12-9 antl IC 61.735-9.
COUNN � TOWNSHIP � YEAR
I
MAR 3 0 zutu
wsrRUCnoNS:
To be filed !n person or by mail with the CouMyAudita o! the wunry where fhe property.is locatetl.
Ftii�y Dates: 1) Real P/operty: Dunrg the fweNe (12) marths 6e/ae December 31 0( the year the deduction is to
2) Mobile Hpnes assessed under IC &f.7-7 or manufectured homes rrot assessed as real p������,1�J8��hs
be%re Merch 37 o/Ne year the deduction is to be eNectiva. .
See reverse side !w add'dionallnshuctions arrtl qualiflcatlms.
�Yoe ot ceoet.� (eaueatea (pae ocx ea u�at evdr)
Over 65 Deduction from Assessed Valua6on Over 65 Circuit Breaker Credit
Name of diCenl (rnnrer a canHac7 DIuye� ,
`
Is epplipnt the wle lepal ore i We owneR If No, what ia hisRier exad share or interest? H on�ned with someone other Ihan spousa.
indi�te wit� whom
❑ Yes ❑ No
N nama on rewrd ie diReeanl ihen Mat d eppGran� indiwte bebw .
Name of contrea seller (epplicenf must have 6een buyinp m tonVaG af least oire (i) yea�
ME�ess U mntratl aaller (numDaa boe4 tey. sbfe, end ZlPcode) Is the pmPe � OuesYron:
Real propery ❑ MoDile home (IC 6-1-1-n
� Tazing disind Key number I Legal EascriMbn RecorE number Page m:mber
6 � �-� - - - - � -_ --
b the pfopeM used end otturoed pnmanly br I Assessed value of tha DroOerty as of Ma�ch 1, wrter.t year (may rrot erceed 5182.d30
NNher (esidente4 fur O�er 65 deduGim, ar 5760.000 fir Ne Over 65 Cucuif Breaker CreEin
❑ Yes ❑ No
Wa.a IAe applkanl65 yeare of epa or mora on December 31 of lhe year
Have you filed fp a�ry oll+x deducfions7 If Yas, what dedudions7
� Yes � No
Have you fiteE M dedudions in eny ottwr courrtyl I t( Ms. wnat counry?
❑ Yes ❑ No
UWe certity under penalty of perjury that the above and foregoing informatio� is true and cortect and thai the applicani was a resident
of Indiana and owner of !he aforementioned property on March t, 20 _
Slgnaiuredappfi�m P4drassofaoo���i (ntonberaiMstreef,ci,y,state.aMZlPcrode)
t
� Sgneture W auNaAZed mstiva rasa of au1��Pise� (c b�rand s•reet, city, state. antl Z/P cotleJ
� % • �T. 8,