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APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
StaOa Fortn 43708 (R9 / 9-08)
Prexnbed by the Depa�menf ot Local Govemmem Finance
InFwmatiom m�tained in this tlocument is CONFIDENTIAL pursuant lo IC 6-1.1-72-9 and IC fr1.1-35-9.
�NSraucnoNS:
COUNTY TOWNSHIP � YEAR
II M fk '
JUN 1 � Zp09
To be filetl in person or 6y mail wifh Ure CountyAudita o/ Ne county where lhe properfy is located.
Filirg Deles: i) Real Pioperty: Dunrg the twaAre (72) monNS 6efae Decem6er 37 o7the year the dedticfion is t� ecWje��
2 MoDile Hames assessed under IC 6-7.7-7 or manu/acturetl homes rrot assessed as real Dun "ZK-eW�(72J monfhs
J be(ore Mer`ch 37�o/Ne year Ihe deduction is fo 6e e/7ective. ' ���N C0� Y q�01TOp
See reverse sitle la edddional insUUttrons erM qualifications.
Typa d henef� rapuested (ploeso Uack a0lhat app�
Over 65 Deduction from Assessed Valuation Over 65�Circuit Breaker Credif �,�`„ ��� �
�. .:
Nama of a0d��1(awnor a cartracl DuyeQ
. ' . . •...�:, a
la aoGf the sde lepal or epuita e owneR It No, what ia hislher exaq share or interest7 If owned with someone other Ihan spouse.
_ ' indicatevAlhwhom ,,� .
❑ Yes ❑ No . . . . .
M name on racad'u diflaraM ihan Uut ot aodran� iMicate bebw
. _. ... ' . .: . _�
Name ot contraa aeller (app7cant must nave Dean 6 yvq m canbaa at kast one (f) yea� � �
Address of contrad seCer (numborand sCeet, cily, sdfa, end ZIP wda) Is the piooerty�in question: '
Real property � Mobile home (IC 644-�
� Taxing distrid Key num6er / Lepal deacnption RetarE number Page number
` o?C- ao-i�-�a3-oao.o�� oo� - ;: ;._ :
Is the propeM wed aM oied pnmariy for Assessed value of the property as of Marth 1, curtem year (may rwt erceed 5182.d30
hivhar resiEence7 hr O�er 65 detludim. ar 5760.000 /oi Ne Over 65 Cirndt &eaker C�eOiq
Ye5 o No .
;
Was the appfiwtl 65 yeare of ape or more on December 37 d the year
Have yw filad br arry other deductions7 � II Vua, what deductions?
� Yes � No
Have you filed ta Oeductiona in eny olher cwmy7 If 1§s, what counry7
� Yes ❑ No
IIWe certify u�der penalry of perjury that the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 �
$ign apOficam Address of appli�m (numDa entl sbeet, cify, stafe, aiM ZIP wCO)
� S' tua of e aized �a entativ� Addresa ol autlmrizad reo�ase�Wiive (nwnbe`anC sbcet. ciry, sfafo, antl ZIP codo)
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