Age_LandAPPLICATION FOR SENIOR CITIZEN C TOWNSHIP re.nR
� ,..n PROPERTYTAXBENEFITS
` '• State Fwm 43T08 (R9/ 9-08) �
Prescribed by the DepaRment of Local Goremmem Financa
Information wnWined in this docvment is CONFIDENTIAL Wrsuant to IC 6-1.1-12-9 and IC G7.7-35-9. AUG d ���afk
INSTRUCl10NS: �p�I��%�
To be filetl in persm or by mail with Ure CountyAUditw olfhe counry where the properly islocafed.
Filirg Dates: 7) Real Property: Durimg fhe fweNe (72) mmths belore December 37 otthe year the tl�1@t$pFy f� UDITOFj�
2J Mobile Homes assessetl untler IC frf.1-7 o�manulacfured homes rrot assessed as reel property: Dunng Ihe 1weNe (7 ) monfhs
6elae March 37 o7the yeer the tleduction is to be etFective.
See reverse si0e 7a atltlitional insLVCt/ons aiM qualifications.
Type ol benefit repuedad (pl se d�ock BO t/iel8ppl�
Over 65 Deduction 6om Assessed Valuation �er 65 Circuit Breaker Credit
Name o( applicaM (owner a cmf2ct DuyeQ
T
U aDD�Kani thB �epal or eQU� We wmeR If No, whai i5 hisRier exacl s�are o i�taresl? N owned with swnaona Wher than SVOUSe.
indimta with whom
❑ Yes ❑ No
tt neme on record is diRe�eM Nan Nal d eppliranl, intlicete beiow
Name W comraa sellar /apd/cant must hnva Ooon buy'ug m convact at �east orw (7) yoe�
� AEdress W contrad se0er (number aiH sbeef, city, sfefe, antl ZIP code) Is the O�oerry in puestion:
7� _ � Real proparry � Mobile home (IC 6-7-7-�
Taxing tlis Kay number / legal dencnption RecoM numCer Pa9e numbar
-a� a ' -
Is ihe property used aM ottuDied pnmarily br ��0.ssessad-va�ue of t e pro� Derfy as a� arch 1, curtant year (may rrof exceed 5f82,e30
hisRier res'Wence7 Por O�er 65 Ootlucfion, a- f760,000/or Ne Ove� 65 Circuif &eeke� CreQin
� Yes ❑ No
Was tha epplkaM 65 years of aBe or more on December 31 W tne year �
amount ot income
individuals aharing ownership (ForOver 65 deduction, income g
may not exceed 525,000; /or the Over 65 Circuit Breaker Credit,
income may not exceed $30,000 for individuals, or 540,000 for ¢�
mamed couples).
' � TOTAL S 0.00
Have you filed tor arry aher deduclions7 If Yes, vrhat deductlons?
�'Yes � No
Hava you fileE fw daEucUOns in any other counry9 If T§s, what courrty?
� Yes No �
IIVJe certiry under penalty of perjury that the above and foregoing infortnation is irue and correct and lhat the applicanf was a resident
of Indiana and owner of lhe atorementioned property on March 1, 20 _
� Signetura d eppfcaM Pdd�ess oi eOPli�nt (number aiM sbool, ciry, sfare, a� Z/P wde)
l� // /�, l
Sgnature d auNOrized represemaWe Addrass ol aWhonzed representative (numDa aM sbeef. ciry, slate, and LP codo)