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Age_RichardsonAPPLICATION FOR SENIOR CITIZEN �P Y� ._-rt• a- PROPERTYTAXBENEFITS • ' . � Stata Fwm 43708 (R919-08) •� � Peesuibed by �he DepaRmerit of Local GovemmeM Finance � Informatirn mntained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. � E C � G ZU7T Mark INSTRUC710NS: C ",' n1°``�(�"""'� To be filed in person or 6y mail with the CountyAud"Aor o7the county whele fhe ryoperty is bcated. V v Filirg Detes: 7) Real Property: Dunng the hveNe (72) mmths hefare December 31 of fhe yearlhe de�18AQYAlt6/TMAf4ec)hdUDITOR 2) Mobile Hanes essessed under IC &1_ 1-7 or manWactured hanes rrot assessed as real property: Dunng the twsNe (12J monUis 6e/we Marrh 31 of fhe year the deduction is fo 6e effecWe. u � � See reverse side Iw additional inshudions arM qualificstions Type d beneH repuasted (J.dease dieck a0 Nat apply) {J Over 65 Deduction from Assessed Valuation �[y Over 65 Circuit Breaker Credil Name d appfrant (annar or cmfrdcf Duyerj /� � . . Is a fimM lhe sde lepal or eQUitaWe owna(7 H No, what is his/her exad share or inlerest7 If awned wilh someone oiher than spousa, inditate xith whom ❑ Yes ❑ No It name on recad'n tliftarerit than Iha1 d apqican4 iiWicate bebw Name of conlaG seDer (applrcant musf hare been D�ryirg m cmlrad af ba5 orie (i) yearj Pdtlress ot cvnbatl seller (n�m6er aM sbaef, city, slale, and LP o000) Is lhe property in queslion: �fteal pmperty � Mobile home (!C &74-n Tani� datrid Key number / Legal desc+iptian Record numbar Paga number Oa-�eo-� -1y-19-10�-oDO, 531- 07 Is Ihe qoperty usetl aM ocwpied rily (or Auessed waWa of iha pmperty as of Mamh 1, wrrerit year (may rrof nrraed 5782,a30 hisfiar residence7 /w 0`er 65 deEUdivi, u� E760.O00 /or Ne O�m165 C'vcmit &ealmrGadiQ ❑ Yes ❑ No Wav the a0d�m 65 yaars of aga or rtrore on Decembar 31 of lhe year Have you filed tn airy other deduct»ns7 If Yes, what deductions? C�'�s ❑ N° I.� . S . Have you fYeO fw daducGOns in any olher wunty7 If �4s, what couMy4 ❑ Yes ❑ No IIN/e certify under penalty of perjury that the above and foregoing infortnation is true and cortect and that the applicant was a resident of Indiana and owner of the aforementioned property on March 1, 20 Sign uredappGpnt AdCressofapplimnl (numberarMSboeLaty.sbfa,arMZlPmd¢) � � J � `/r nalure o( aulhor¢ed resentative ACdrass of aNtror'rmE reprasentat'rve (number arM sLOet, cify. �at4 enE ZiP w0e)