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APPLICATfON FOR SENIOR CITIZEN couNn TOWNSHIP rena
,_ _ PROPERTY TAX BENEFITS
`S ''• State Fortn 43708 (R9l 9-08)
� uo P�escnbed by the Departmer� ot Loral Go`emmeM FNance
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Infortnatiom m�tained in this tloa�ment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC 6-1.1-35-9. �UN 1
INSTRUCTIONS: C�.��
To be filed in person or by mail wRh the CourrtyAudilor of the county where fhe property is located.
Frliry Dates: 1) Real Properfy: Dunng the tweAre (72) months be(ore Decem6er 31 0l the yearfhe deductior���lI��TY ALlD ITOR
2/ Mobile Hanes assessed urWer IC 61.7-7 or menu/actured hwnes rrot assessed as real pmperty: Durirg the fweNe (12J mmths
6e(ore Mardi 37 07 the yeer fhe deduction is l0 6e eRective.
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See reverse side 7ar adtlifionel ins6udions and quali6catims.
Type d banef.t reQUe9ed (please Meck all Nat appy)
� Over 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Nama of appGrarit (owner w contiact buye�
c
Is applimM the sde legal or aquitade e(! H No. whal a hisiher ezad shara w inlarest? If owned with sumeone other Ihan spouse,
indirate with whom
❑ Yes ❑ No
H rame on record is diflarem than Wt a( appfKant ���e bebw
Name of mMraa seAer (app�rcant mvst ha�e been buyirg on cmtracf af lcasf one (iJ yea�
AEdrasa d mntrad sa0ar (num6er aM stree4 u�', sGte, ad ZIP roCO) Is ihe P�PaM � 0��:
eal pmperty � Mobile home QC 614-�
Taxing daUip'� Key num6er / Legal descnptqn _ Record number Paga number
l �/
�/ � -a-i�-io � -o . �9 a8=
Is the WopeM used aM ocwpeE pnmariy br � Acrossed value ot tha p(oParry as of MaN� 1. curreM Y�r (may not exceed SiH2,130
hisiher residanw7 !or O�er 65 de0udian, m f760,000lorNO Ovef 65 Ci'cruf Brealmr Credit�
❑ Yes ❑ No
Was the appGrant fi5 years of epe v mae on Oacembar 31 of 1he year
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Hava you filetl fw airy olher detluctions7 It lgs. what deductions7
�Yes �No •
Hava you fdad for daductions in any other cwntyl H Ws, what couerty7
❑ Yes ❑ No
IIVJe certify under penalty of perjury lhal lhe above and foregoing in(ortnation is W e and cortect and that tha applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20
Signature appf�r� Pddrass of applimM (numbea�M stroel, cify, sfate, arid ZIP oode)
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Signaturedauth � rap ntatirve Adtlressafautha�drapresenffiive (nwnbr�aridshae4�Y,sfaEe,andLPcodo)