Age_Risinger��'"' APPLICATION FOR SENIOR CITIZEN couNn TOWNSHIP � rena �
PROPERTY TAX BENEFITS
State Fortn 43708 (R9l 9-0B)
S u,. '� prasaibed by �he Departmerrt o1 �ocal Govammerit Finance
' File Mark
Informatiom m�tained in this docvment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC �� ���
INSTRUCT10N5:
To be fi/ed in person or by mail with the CountyAUtlitw o! the county where the property is located.
Filirg Dates: 1) Real Property: During the AveNe (12J months belore December 3 f ol fhe year ��ction is �q��ffecfive.
2) Mobile Hanes assessed under IC 6-7.1-7 ormanufectured homes rrof assessed as real prope�:-DUfirn] fhe fweNe (72) monNs
befae Marrh 37 of the yea� the deduction is to 6e eHective.
t`❑
�
See raverse sitle 7or atld4ional insWdions arrtl qualificatiwis. �I%� ��
Typedbenef.t�ue5lad�peaSaMeckaOfhatapply) �Ie�Gn COUNTY AUDITOR
❑ Over 65 Deduction from Assessed Valuation �ver 65 Circuit Breaker Credit
Name of applifanl (avrtrer or conhact DuyoQ
Is apo�uarrt the sae lepal oreQuitaWe a/1 If , what is hisR�er eaatl share or imerast9 N owned with someone other than spousa.
indinte with wtwm
� o No
If name on racorti is diftareM than Ihat of a0d'zant indiwte belaw
Name of crnt2cl seller (applicanf mvst have been Duyiig on contrac! at bast ore (1) yeah
Pddress N trad saller (number arM sbee4 tM. stafe, arM ZIP coEe) Is the pmDerty in Queslion:
� Real property � Mobile home (IC 6-14-n
Taaing distnct Key number I Legal dascn0�� Recwd number Pege number
p�- �'/9�31_=�3ba=-dc�v��a- - -
Is �he o�PeM1y used and occupied pnmariy (or Assassed value of the property as of March 1, curtent year (may irot ercce05f8Z.a30
hisrher ras'�dence4 !or O�er 65 dotlurtbn. ar 5760.0001or No Ovor 65 Cticurt &eekef Crodin
� Yes ❑ No
Was the eppli�art165 years of age or more on December 31 of the year
Have you filed for any mher deductions? If Yes, what deducUOns7
� Yes � No
Have you fied fw deduc6ons in any other cwnry7 �� ffis, what counry?
� Yes ❑ No
I/We certify under penalty of perjury lhat Ihe above and foregoing information is Irue and cortect and that the applicant was a resident
of Indiana and owne� of lhe aforementioned property on March 1. 20 _
$gnature W ap0���1 Pddress of eoPlitant (mxnbcr antl sbool. ciry. SWte, and ZIP mtle) '/-7 3
�,(�_�, � � �{O% �- �i�SO � �t
Signatura of authonzed resantaUv Address ol authonzad represantative (numbor ana streef, ci , stafe. and ZIP cotle)