Age_Foster�
�1]
C,
��.
` .^_'4
APPLICATION FOR SENIOR C171ZEN
PROPERTY TAX BENEFITS
Sp1B Form 43708 (R9 / 9-08)
PraxAbeO try Me DepaRment of Local Govertmem Finance
IMOrtnetbn contained in Ihis document is CONFIDENTIAL pursuan� to IC 6-1.7-12-9 and IC 6-7.1-35-9.
���(�I� 1— �W\
� ` ���
,
� . i� .
INSTRUCTlONS: " `s`� ��
To be filetl (n person or by mail wiUi the CountyAUtli�w olthe wunty where Ure property is locafed. OIBSON CpV/��V
Fili�g Dalas: iJ RealPioperty: Dunrg the tweNe (72) monNs befae December 37 o/lhe year the deduction is to be ei(eCfi�UD)70p
2) Mobile Homes essessed urrder IC 61.1-7 ormanufecfured homes rrof assessed as real proper(y: Dunrrg the tweAre (72) montns
belore March 37 o/tAe year the deduch�on is to be eNacfive.
See reverse side lw addilional insWdions e� pualificafions.
Type of benafi �uatleE �please dixk a� Nat appiy)
er 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credii
Name ot ap0licar�t `- J/ cv v,..) Q �
is aooiimm cha sde iegai or eQUaawe amen If No, whai is hisRier azact share or interast9 If owned with mmeone o�her t�an soouse,
inditate vnlh wham
❑ Yes ❑ No
N name on recrord is diRaraM ihan that d eDd'��t in0icate balox
Name of cont2d aeller (appqcanf musf Aeve Deen buyirp on cmUacf at least orre (i) yea�
Pddress of contrad seller (nwnDw end abeet, cdy, sfale. eM Z/PcoOe) Is Ihe pmoerty in puesiron:
�Real pmperty � Mobile home QC 644-n
Ta`ing di ' Key number I Lepal descnplion Record number Paga numEer
�
-i -6 -h�o�/-�oo.g`/ -o
Is ihe v�0erty useC end attupied pnmariF/ br AssesseE valua ol ihe property as ol March 1, wnenl year (�Y �� exceed 51B2.630
hiNAer (asidente7 for O�e� 65 deducfi�on, a 5160.000 lo� Ne Ovai 65 Ci�cuit 9leakar C�eOi�
� Yes ❑ No
VJas the e0W��165 yean o(age w more on Decamber 31 of the year
Have you filed kr arry other deductionsl I( Yes, what deductions?
� Yes � No
Mave you (Jed for de0uctions in any other courrty7 �� �§s, wnat counry?
� Yes ❑ No
IIWe certity under panalty of pe�ury that the above and toregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signaturaof pficarrt FWtl�assolaoo�����(�wnbcranCSWOf,ciy.stata.aritlZlPcod)���;nLl"""_` ��/�O%V
' ..G6?i. D� I ` �I/� C' `-�'�i���UT� / %A 87! .
Signatu ofaiRhonzeErapresantative AGdrassotauthonzedra0�asertative (numbwandstrcoCcity.4afe.anOZIPcoCe)