Age_HuntP
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" APPLICATION FOR SENIOR CITIZEN co r Ns R i
PROPERTY TAX BENEFITS
� State Form 43708 (R9 / 9-OB) .
�� u� � P�asaibed by Me Depanmenl of local GovemmeM Finence
Infwmation wntained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 anE IC Cr1.1-35-9.
JU�83ta�k 2009
�
INSTRUCT10N5: � � ��
70 6e filed in person oi by mail wifh the CountyAudifw o/ the county where the property is laceted.
Filirg Dates: 1J Reel Property: Dunng Ure tweNe (72J months belae December 37 0l tAe ysar the deducfion is to �BiS�d�OUNTY AUDITOR
2) Mobile Homes assessed urrder IC &7.1 J or manulacturetl homes irot essessed as real pioperty: During fhe hveNe (12) months
before March 31 0( Me year the deduc6�on is to be eHective. .
See �everse sitle 7or add'dionel lnstruUions aM Ouafifications.
Over 65 Deduction from Assessed Valuation
�
� If NO, whet i9�iiLffB� exa[I shara w iftB�B51?
�� � N� �
H reme on reco�d is diftarem Man that d aopGCanl irMicete bebw
Name of mil2d satler /a�cant musf liave beon Euyirp m confract al kas! orw (1) yee�
Addeass o( contratl saDer (numbw aM stroe4 city, sfate,
Key number / Lepal dexnption
' � � � � d '
U iha omceM used anO ottuMed vrimariN (or
hivher resideno7
�Yes ❑ No
Was Ihe eDM�m 65 yean of age a mae on Decem er 31 of the year
priortotheairtarMyea(! �
❑ No
Adjusted gross ineome of appliwn; pouse, and any
individuals aharing ownership (For Over 65 deduction, income
may not exceed 525, 000; for the Over 65 Circuit Breaker Credil,
i�ome may not exceed 530, 000 for indivrduals, or 840, 000 for
mamed couples).
Hsre you rued fw ar�r w,er eaeuction,a
� No
Nave you fJed tn deductioru in any other coumy?
❑ ,�S �
65 Cirtuit Breaker Credit
M rnmed v.ith mmeona Wher Nan spo�se,
inditate wittM whom
Is tne pmoeM �� auestbr.:
pmperty � Mobiie home QC G74-�
iumber Page numear
sessed value of che proDerty as of March 7, curteM year (may not exceetl 5t82,d30
0`er 65 tlotlurlion. or 5760,000lor No Over 65 Circuit &eaker GediQ
IM/e certify under penalty of perjury that the above and foregoing information is lrue and cortect and that [he applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _ '
Signatufadappficar� Pddrasaofappliqnt(numbaia�streef.ciry.sble,aMZlPcode) �
\ _� _ . � � N / f I .
AEdreaeotaultrorizadraoresentative (numDeralMS✓eet,ciry,5a:e,andLPCOde)