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•yS��a APPLICATION FOR SENIOR CITIZEN
• PROPERTY TAX BENEFITS
Sla�e Form 43708 (R9 / 408)
Prasaibed by Ne Dapartment of Local Go�emmerit Finance
Informatian containeA in ihis tlocument is CONFIDENTIAL pursuant lo IC 64.1-12-9 and IC 6-1.135-9.
wsraucnoNS:
COUNTY TOWNSHIP YEAR
8
OCT 3 2011
To be filad in person or by mail wHh fhe CountyAuditor of fhe county where the property is lacated. C�
Filirrg Datas: 7) Real Property: Dunng fhe hveNe (72) monihs bePore Dacember 31 07 the year the deUuction is to 6e eflecfi�s.
2)MO6i/eHomesassesseUurMerIC67.7-7ormanu/acturedhomesrrotassessedasrealpropGfBSONCO NTY�AZDITOK
befae Mardr 37 o7the yearthe deduction is to 6e eflactive.
See ieverse side !a adddionel insWciions arn/ qual'dicafims.
tyca d eenef.t revuested (daaso meck aa u,af anWr) �/
�Over 65 Deduction 6om Assessed Valuation {�Over 65 Circuit Breaker Credit
Name of appGcaM (ownei w canhaU buyeh \
/
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If owneC with somaone othar than spwm.
irMimte xith whom
❑ Yes ❑ No
II rame m �ecwd is diReeem Nan tlul of appGrant, iMicate babw
Nartre d mntract seller (aPPricant must have boon buyirg m cmfracf af kast one (+J YeaO
ACdress of mntrad wller (numbor anE sbeeL �+ty. stale, aM LP mde) Is �he pmperry i^ question:
�eal pmperty � Mobile home (IC b7-1-�
Tazingd'aMct Keynumber/Lepaltlesuiplion Recordnumber Pagenumber
� -oa - sq-o�3_�0.o d _a,
Is Ne pfope eO aM occupied p(imarily br Assessed value of the property az ot Marrh 1, wrterrt year (may irot erzeed f181,430
his/Aer rasiCanm? /or O�e� 65 deduGn, n ff60.000IUr fhe Ovar 65 C'ucMf &val�rCrediQ
�Yes ❑ No
Was ihe ap�m 65 years ot ape n mora on Dacamber 37 af ihe year
Hav¢ you fJed (or eny olher daEucbons7 1! Ws. what deCuclions?
�Yes � No /-�.5, �'t
Hava yw filed fn Eeductians in any other couMy? Ii 1§s, what cou�?
❑ Yes ❑ No
UWe certi(y under penalty of perjury that the above and foregoing infortnation is lrue and correct and that the applicant was a residenl
of Indiana and owner of the aforemenlioned property on March 1, 20
Signalura d applirant P.ddress of aPalirant (number arid sboet, dty, sfafa. a�M ZIP mda)
� �a S,o � S ), '�92,��nr � l�
Sipnatu�e d aulh rrzed rapreseMativa Atltlress of aNhwizad representative (numberaM slleef, city, slatq entl LPcotlo)
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