Age_BuyherAPPLICATION FOR SENIOR CITIZEN courm rowNSHia r�
,; ,.., !. PROPERTY TAX BENEFITS g � �
Spte Fortn 43708 (R9l 9-08) a �
� Prescnbed try ihe Departmertl of Loral Govemmern Finance g
Fle Mark
Informatiom m�tained in this tloct�ment is CONFIDENTWL pursuant to IC 67.1-12-9 and IC Fr1.13S9. O[ f` ��I ZO„
Cl. D
INSTRUCTIONS C � n, " V
To be filed in person or 6y mail witl� the CountyAudRor of the county where the property is locatetl.
Filing Dates: 7) Real Property: Dunng the hveNe (72) maMhs be/ae December 31 ot the year fhe tleduclion is tu be eflecfirvs.
2) Mobile Hwnes ascessed under IC 67.7-7 ormanufactuletl homes rat assessed as real ploperty: D�ri�'i���in��ITOR
be/ore March 31 of Ne year fhe deduc6on is to be e/lective.
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See reverse side lor additional instruclions and qualifirations.
Typa W beneft repuested (please dieck a� Nal aPply)
Over 65 Deduction from Assessed Valuation IX I Over 65 Circuit Breaker Credit
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Name of applirar�t awxr or cartrdcf buye� �
e,�C, � f Q�-C�e►..�
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Is GmM ihe sde legal or ea ' e amef! H No, a hisiher exad share w iMerest? H ovmed wilh mmeone other than spouse.
itMimia wi�h whom
Yes ❑ No
If name an rewrd is diRe nt lhan that of applican4 �ndicate below
Name ot lmtrdr� seDer (appGcanf must have beon buy'ug m cmlracf al bas! ox (1) yeah
Address d mntrad seller (num0or aM sbeet dry, stalo, arM LP wda) Is the pmperry in Question:
Real pmperty � Mabile home (IC 6-14-n
Tati(g datrict Kay number/ Legal description Record number Page number
� �o - O -GG� �Q� 06
Is the pmparty usetl and xwpiad ' r Assesed valua ot the property as of Marrh 7, wRem yaar (may lmt exceed f182,a30
his/her residen�s7 for O�er 65 dedudian, m 5160.000 h�NO O�vr 65 C,'ucuf &aa/sr Gcdi�
❑ Yes ❑ No
Was the app5reM 65 years o(aga w more on December 31 of lhe year
r��a yw maa ror am aner ded�,s� u�, wna� dad�worua
Yes � No ��
Have yo� fded tw tleductions in any aher counry? If �§s, what munry?
� Yes ❑ No
IIVJe certify under penalty of perjury that the above and foregoing infortnation is true and wrrect and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20
Sign ppGCartl ACdress of apptiant (mvnbe aM stroot city, sFate, and ZIP wde)
/ ._ 2,0 �✓� op�� �K�.,.bcr�j���- y�G�o
Si aluie W a�lhorizetl representative Address of aufhonzad represe^talive (numbrla�stmof, cdy, sfate, and LP crode)