Age_MountsAPPLICATION FOR SENIOR CITIZEN cour+n TOWNSHIP rena i
PROPERTY TAX BENEFITS
, ... -'' Spte Fortn 43708 (R914-0B) 1
� � � Preacnbed by the Deoartmerrt of Local Govemmem Finaxe
Infwma[iom m�lelneC in this documen� is CONFIDENTIAL pursuani to IC 6-1.1-12-9 and IC 61.1-35-9. A P��9 AAatk ZO �O
8
�NSrRUCnoNS: �a� � �
To be (led in person or 6y mail wiN the CotartyAuditw o7 the county where fhe property is located.
Filirg Dates: 7) Reel Pioperty: Durirg fhe AreAre (12) monfhs belae Decembar 31 o/the ysar the deduction is to ����OUNTY AUDITOR
2) Mobile Hames essessed urMer IC &7.1-7 ormanutectured homes �rot assessed as real property: Dun� the MeNe (72) monfhs
be(qe Mamh 31 0l the year fhe tleduction is to be eflective.
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See reverse sitle fa atldQional irutrudions eM qual'dications.
Ty{p d betreN �epua�ad (please d�eck e6 Naf app�y)
Over 65 Deduction hom Assessed Valua6on ❑ Over 65 Circuit Breaker Credit
Name d aoai�m �o»„e. a cmnaa euye�
- P
la eppliram e sde lepal or eQUita ameR If No, vrtiat ia hisRier exacl shar . erest? H ovmed with someone Wher than sow�se,
indi�te wilh whom
�Yes ❑ No
tl name on raco�tl ia diReraM ihan Ihat ol epdirant inEicate bebw
Name of comrae seAer (appGCanf must have Deen buying m canvact af least oim (1) yee�
Pddress d mntrad ee�er (numDOr ad sboe4 cdy. stafo. antl ZIP code) Is tne o�oerty in puesiion:
�Real property � Mobile home (IC 6-14-�
Taaitp tlistnd Key number I Legal descnpiirn RecorE numGer Page m:mber
� al>��,- -ao - -o
la �he property used anC accupieO primarily br Assassed value ot lha prooerty as of Ma2h 1, curter.t year (�Y � erccc0 5182.a30
hisfher resideno7 Ior O�er 65 doducfim, a Sf 60.000 hr Na Ovor 65 Ciicuit &oaker CmOi�
�YeS o Na .
Was the aoW�M 65 yean of age w more on December 31 of t�e year
Have you filed tor erry olher deductions9 If Yes, what deductions?
�es ❑ No
Have you filed for deduGbns in eny other courityl If 1§s. what courrty?
� Yes �NO �
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IIVJe certify under penalty of perjury that lhe above and foregoing information is true and correct and that the applicant was a residenl
o( Indiana and owner of the aforementioned property on March 1, 20 �
Sipnature d apprraM Pddresa of applimm (numbe� arM sbeef, ciry, stefe. a� ZlP code)
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Sy ure o( euN ed rmematiw Addresa of au1 raorese • iive (numDeraid s;rce; ciry, slato, end LPCatlo)