Age_Smith (6)�\
�
X
�
" APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
Srate Form 43708 (R9 / 9-08)
S �•� � PrasnibeA by the Dapa�merrt of Local Govammem Finance
Informatiom m�tained in Nis docvment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7-35-9.
in.l.Jfi i •'�I� ;��y _�
f c y . ���
1 l' Rt 1
WSTRUCTIONS: �� (Q/.�
To 6e filed in persm or by mail wifh fhe CountyAuCrlor o1 fhe county where Ne property is locatetl. ��
Filirrg Dates: 7) Real Pioperty: Dunrg the fweNe (72J monfhs befwe Decem6er 37 of the yearthe Ceductior��9�t�c�NTY AUDITOR
2) Mobile Homes assessed urMer IC 6-7. 7-7 or manufactured homes rrot assessed es real property: Dunrn,7 the tweNe (12) mond�s
be/ae March 31 0/ fhe year the tletluction is to 6e eHecfive.
See iBVerse Sitle !or atld'dionel inslrudions arid qualfications. ,
TYDa of berrefl reCUB5te0 (Wossa rhock aD fhaf aPM'I
� Over 65 Oeduction 6om Assessed VaWation Over 65 Circuit Breaker Credit
Name d applicaM (ox+�er a ca#2d DvyoQ , .
.�.��� �� v �
b aoormm ma sde iegai or euunawe ownen I( No, w. is hislnar exad share w inie�estt ttawned vnth someone other than spouse.
indifate with wMm
❑ Yes ❑ No
H name on record is CittareM Man thal o( anMiran� indicale bebw
Name of contrzd selier (appGcant must hare becn buying on caN.rac! at leasf orre (1) yea�
Pddress d mntrstl seller (numbw a� streef, cdy, sfate, and ZIP mde) Is lhe D��erty in pue5ti0n:
-�Real property � Mobile home (IC 6-74-�
Tazing disinct Key number I Legal tlescAViion Record number Page number
-�9-�9-�0/- 000, �3�- a-�
Is Uie o�0erty used and ottupiad pn:naAN �� Assessed valua of lhe property as of March 1, cuneM year (may nof exceed 5f82.d30
hisfher resiOence7 for Orer 65 deduGian, a S 1fi0.0001oi Ne Oi+.v 65 Cticuit &oaker Gadl�
�Yes ❑ No
VJas lhe apWican165 years of aga w rtare on December 31 of lha year Apo��nfs da�a of birth (month, Oay, yoa� If fileG by a suniving, unmartietl sDOUSe,
D�iO� �0 �he airtartl yea(7 what was the spousa's aga at the lime
��s ❑ Na �
Amowrt oi Income
individuals sharing ownership (ForOver 65 deduction, income / S
may not exceed 525,000; Po� the Over 65 Ciro�iit Breaker Credit, .7
income may not exceed 530,000 for individuals, or 540,000 for g
mairied couples).
TOTAL $ 0.00
rwve yo�, llae ror sny olner deducEw,s7 �r T§s, rna� eaducUonst
,�5 ❑ No �+ s r,t
Mava yau filed fw deduc6ons in any olhar counry7 If �§s, what counry?
� Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is Irue and correct and fhat the applicant was'a resident
of Indiana and owner of lhe aforementioned property on March 1. 20 _
Signeture af a��icaM AdEress of aoo��mr.t (numbcr and strool, ciy, sWre, and ZIP codo)
� %mo earc '76�f
Signatura of auu�«;zed rao�esemawe Address of authorized raprasentative (numEw aM sbvet, city, sfato, and Z/P o)