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"'". APPLICATION FOR SENIOR CITIZEN COUN Hi
,_- _ PROPERTYTAXBENEFITS
Stala Fartn 43708 (R9 / 9-08)
•' � P�escnbed by the Departmerit of Local Govemmem Fnance
2U11
Informatiom m�tained in this tloaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC G1.L3S9.
iNSrnucnoNS: �\
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To he tded in person or 6y mail wrfh fhe CountyAuditor of the county whera fhe property is located. _ V
FilingDates: 7)RealPmperty:DunrythehveNe(12)monthsbe(aeDecemtr=r3l�olfheyearthetletluUionisto6e�r��COUNTYAUDITOR _
2J Mobile Hanes assessed wMer IC fr1.1-7 or manu/actured homes raf essessed as ieal property: Dunrg the fwelve (72J montlis
be/ore Maai� 31 0/ the year fhe deduction is lo be eflecfive.
See reverse side for additional insWUions antl qualifications.
tyoe m eenef.� requasf (please rheck aH Nat apply)
Over 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
NamadappGrarit orcmtracfAUynrJ ` �/`�""' -
// ,%�/�� /y�G�
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Is appGmrrt tha e lepal or equilaWe amar! H No, what is hivher ezact share or interest7 If owne0 wilh wmeone Wher Ihan spouse,
iMimta wilh whom
�Yes ❑ No
H name on recad is diflaiem than that of applimnt ��d'wale bebx
Name of mrtad se0er (a�cantmasthare Deen Ouying on canfrdcf atbastorre (1J yea�
AdLrass d mntratl seAer (nunbrr aM stree4 aty. sfa ZIP roCe) �s the `operty in questirn:
//�`% �� �� ��� .��' �j6� Real property � Mobile home (IC 61-7-n
f e+a,
Taxi�g d¢trict � Key numbar / Legal des�iption Record number Paga number
d6-/-�-�e�-/a3 _o03. a- ,2
Is Pa property used anC oaupieE prinurily lor AcsesseE valua o( Lhe property as of March 1, artam year (may rwt e:ceed Siffi.a30
hisTher resitlanre? IorO�er 65 ded��6:m, or Ef 60.000 hrNO Over 65 Ciranl8realwi Credif)
Yes ❑ No �
Was iha app&aM 65 years ot age w mrne on Oecember 37 M lhe yaar
Mave yw Ned lor a�ry olher deEummsl H Yes, what CaGuc0ons7
❑ Yes � No
r�e ya, eiaa �a daau�� �� ar,y aner ��yr it �. �� �,�ryz
❑ Yes ❑ No
UWe certify under penalty of peryury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of ihe aforemen6oned property on March 1, 20 _
S�p� a rit Address of apP�^t (nvn0orantl sbeet, dry, s7ab, a ZlPCada)
// 61-� ��j'��� �'/ �'.f/�'l-�TO
Sign u authonzedreprasem ' e AdtlrassafauthorizedrepresentaWa (numberaMsfinef,city.state,andLPcado)