Age_Morrison" APPLICATION FOR SENIOR CITIZEN courm Tf7WNSMIP rena
_ . PROPERTY TAX BENEFITS
Sfate Form 43708 (R9 / 9-OB)
� S u, � Presvihed py ihe DapartmeM of Local Govemmenl Finance
ark
Inforrt�atiom m�tained in this document is CONFl�EMWL pursuant W IC 61.7-12-9 and IC 61.1359. �U L 2 Q
INSTRUCTIONS: C � � � ���-�-y
To 6e filed in person or by mail with tha CountyAuditw o/ fhe county where the property is lacated. v v
Filirg Dates: 1) Real PropeRy: Dunry Ihe AveAre (72) mwrths be/aa December 31 o7the year fhe de�����tiYeAUDITOR
2J Mo6ile Hanes assessed under IC 67.1-7 or manWactured homes rrof assessed as real property: Dunig the tweh.e (72) months
before Marrh 37 0/ the year the tletluction is to be eflective.
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See reverse sMe for atlddional insWdions and qualifiwfions.
Typa d banef.t reque9ed (please rhefX a� Naf aPply)
�Over 65 Deduction (rom Assessed Valuation � Over 65 Circuil Breaker Credit
that of appGunt ifM'cate bebw
Name af con12G 5¢Iler (app/icant must hare been buy'ug on cmVad at leasf oiro (1J yea�
Pddress of mntrad seAer (num6erand sbeaL �; sb�, a�d LP mEe) �s the pmpe�ty in pueslion:
� Real pmperty � Mobile home (IC &14-n
Ta�c' g tricl . Kay number / legal Eescription Recartl number Page number
� 6-/a-o�-3a/- «�i 8s� z8
Is Ihe qoperty used aM occupieC prirnariy for Assessed value of the pfope�ty as af Mamh 7, wrter�t year (may rrot erceed S1ffi.430
his/ner rasitlence7 /or Owr 65 tlatludion, uf f760,000 far the Ovev 65 Cirtrit &oa/mr Cred�Q
�Yes ❑ No
Was ihe app6rarit 65 years of apa or rtare on December 31 0( lha yaar
Have yau filetl for a�ry olher deEUmwis7 If Ws, what deCuctions?
�'�S ❑ No H 5, r1
Have you filad tor deduc6ons in any ather munry7 If 1§s, what couMy?
� Yes ❑ No
UWe certify under penalry of perjury that the above and foregoing information is true and correct and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 _
SignaturadeppGw(rt Atldressotapplimnt (num0oraibsboef,dty,stafe,aMLPwdo)
� ia-9 5 S�F�C KSo.v S-. PR��i.�E�Fo11, i�v ���
Signatureda ori ra0�santative AddressotaWhorizedmpremntative (numberaiMsfine4�Y.�afn,antlLPCade)