Age_Lawrence�
'"'" APPLICATION FOR SENIOR CITIZEN cout7iv TOWNSHIP venn�t
-- d PROPERTY TAX BENEFITS � � T
S� f State Form 43708 (R9 / 9-OB) �
� �., PrescnbeE by Ne Da�ierrt of Local Go�emmeM Finance
File Mark
Informatiom m�tained in this tlowment is CONFIDENTIAL pursuant to IC 61.1-12-9 ana IC G1.1-35-9. I A N c) C Z��Z
Jh1 H O
WSTRUCTIONS: C �
To be fded in person o� by mail with the CountyAuditor of the county where fhe properry is lacafed.
Filim� Dates: 1J Real Property: Dunng fhe tweNe (72) months be/ora December 31 0! the ysar fhe deduction is to be eflectns.
2) Mobile Hanes assessed uiMer IC 67.7-7 or manWactured hwnes rwt assessed es real pmpeiry: ��i�'�� �OR
C
�
� �
�
before Merrh 37 of the year fhe Ce�ucSOn is to 6e eflecfive.
See reverse sitle for additional instiudions and quali6catims.
Type d 6eneft repue9ed (please Meck a0lhat aPply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name d ap (ownw w cmfrdcf 6uye�
Is appGmm tha sde lepal or equilade owneR tl No, whal is hisTher ezad shara or interast7 N owned vriih somaone other lhan apouse,
indimta with whom
❑ Yes ❑ No
It name on recpd is diHerenllhan Ihat of aOP���I ��di�ate bebw
Nartre o( mftratl se➢er (appficanf must have bern buying m cm4acl at lvasl oire (1f yr,a�
Addrass ot mntrad wlier (numDa and sbeeL dry, stafe, erM ZlP wde) Is the pmperry in question:
�( I Real property � Mobile home (IC &7-1-�
�"'<
Ta�c' iriq � Key number / Lepal tlewiption Remrd num6ar Page number
/-./1.r.rcC�� _ a , o _ 6 0�Z. �3 s� a�'
Ls the ptoperty used aM ocapied primarily for AssasseE value of tha propery as of Ma`ch 1, werem yaar (may irot exceed 5182,a30
his/ner �aSiEence7 /or Ouer 65 dedudim, or f 760.000 /or Ne Orer 65 Circ(ul8reeker CreEiQ
❑ Yes ❑ No
Was 1he appGCam 65 years ot aga w more on December 31 0( Lhe year
Have yau (li ed im arry W her tleCU�ons7 If Ms. wha� dedurliorm7
� Yes ❑ No
Have you fJed for deductions in any Wher wunry7 It Yes, what munryl
❑ Yes ❑ No
IM/e certity under penalty of perjury thal lhe above and foregoing information is true and cortect and that ihe applicant was a residen[
of Indiana and owner of the aforementioned property on March 1, 20 _
Signatura dappfirant Pddress of appli�ant (num6rlantl sbeeL aty, stale, aMZlPCOde)
C� I �'��
a
Signature d auihorized reprasarrtative Address of a�ehaaed represe iva (numDw arN sheet, rJfy. sfate, and LP cade)