Age_Linxwiler� APPLICATION FOR SENIOR CITIZEN courin TOWNSHIP r� �
PROPERTY TAX BENEFITS
Stata Fortn 43708 (R9 / 9-OB) � � � �
•� - j Presuibed by Me Dapamnem of Local Govemmanl Finance
Fle Mark
informatiom m�tained in lhis doaimenl is CONFIDENTIAL pursuanl lo IC G7.1-12-9 and IC 61.1359.
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�NS�ucnoNS: JUL S 2011
To be filetl in person or by mail with the CountyAurfifw ol (he munty where the prope 1 t
Filing Dates: 7) Real Property: During the (waNe (12J mmths befae December 3 o�e yea d uclion is to be eAecti�s.
2) Mohile Homes assessed urrder IC 67.7-7 ormanWactured homes rrof assess s pioperty: Dunng the hvaNe (72) mon7hs
be(ore March 37 ofthe yearthe deduclion is to be eNectiv618SON COUNTY AUDITOR
See reverse side fw adddional insWctions erM qualfiwtions.
Type N beneH repuestad (please Meck a➢ Ihaf apply) �
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name o! appGraitt or cartr�act bu}eQ � '
Is appGmM Ne sde lepal or eQUifaWe owneR H No, whal is hisA�ar eraG share u'unerest7 II amed vrith mmaona othar Ihan soausa,
'vitli�e vrith whom
Yes ❑ No
tt name on remd "u CiRererM than that d apq'xzn� inEicate bebw
Name af conl2 sePer (appficanf must have baen b�ry'ug m cmlraG af /easf orre (iJ yeaQ
Pddress of saller (numberaM sbeeL dry, sYdle, anE LPwde) Is ihe pmperty in quastion:
� Real property � Mobile home (fC 61-7-�
Tax' dist(iG Key number / Lepal description Recmd number Paga num6er
a�-oµ-a�F-3a3-c� �-oaa
Ls e praperty u58E anE occupied pnmarily br Auessed value ol the p�vpeity az of Ma� 1, wrtm�t year (may rrot exceetl 57H2,430
hisTher raziEenm7 /orO�er 65 de0udin; ar 5760.000 (orNe Ovar 65 Cucidl &oalmr Gediq
Yes ❑ No
VJas Ihe appfimm 65 yaars of age or mwa on December 31 of the year
r��a yw r�aa ror �+r mnar em�sr u �m, �� a�cor�x
� Yes ❑ No
Hava you filed far deductions in any other wunry? If l§s. what murrty9 �
❑ Yes ❑ No
VWe certify under penalty of perjury lhat the above and foregoing in(ortnation is true and correct and tha[ the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SpnaWredaOd�nt Addressofapptinm (niunGerandstroe4�:�ro,arMZlPcode)
a� � 1° �s zd � t� y7�� c
Sipnature d auNarized represemative Pdtlrass ol aulharimd rapremntaWa (numbrlaiWi'd streot, dty, sfato, and LP cado)