Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
Age_Wright (6)i.
���APPLICATION FOR SENIOR CITIZEN courvrr N IP r
PROPERTY TAX BENEFITS
Sfa�B Form 43708 (R9l 9-08)
� ! Prescribed by ihe Departmerrt of Loral GovemmeM Finance
� 1
Infwmation containetl in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 antl IC Fi7.1-35-9.
c.�.M�
wsrnucnoNS:
Tobefiledinpersonor6ymailwiththeCountyAuditerolthecountywherefhepopertyislxated CaIBSONCOUNTYAUDITOR
Filiry Dates: 1) Real Property: Dunng the hveNe (12) months 6elore Decem6er 31 0/ fhe year fhe tleduction is to be efleclive.
2) Mobrle Homes assessed urrder IC bf.1-7 or manNaGuretl homes ra( assessed as real property: Dunrg fhe hvelve (12) months
�
�
i�
6e/we Marrh 31 of the year the deduction is (o be eReclive.
See reverse sitle (w atldilional insWdions alM qualifiwtions.
Type d beneft reQUestad (please d�ock a➢ fhat appiy)
Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name d a nt (owrw or cakmGWye� �
�
La app M lhe sda lagal or apuitaMe If No, what is is ar exaa . re or interest? tt mmed vrith swnaone olher than spousa,
indimte with wtpm
Yes ❑ No
H name m racwtl is tliRerent than Ihal of appfrant, iMicete below
Nartre of cantrad seller (applrcanf must hare been b�ryirg m cant2d at bast orre (1J yeaQ
ACtlress af wntrad seller (n�mbaran0 sbeol, city, sfafa, arM LP wde) Is the pmPeM �n quastion:
�Real property ❑ Mobile home (IC G1-7-�
Ty� sirid Key number I L al description Record numbar Page numbaz
� - %- a �00.3. ,i.�3 -oa�
La Ihe pmperty used aiM occupied primarily (or Assessed value ot the pmperry as o( March t, wrtent yaar (may rwt eiceed S7B2,430
his/ner reSiEan�7 � Ove/ 65 Cedurl:un, ar 5760,000loi Ne Ovai 65 C"vcuit B/oeker CreCi�
❑ Yes ❑ No
Was the appGmM 65 years of age n more on Oecembar 31 of the year
Have yau filetl fw arry Wher deCuUbns? tl 14s, what deduUiarvs7
Yes � No .�� °� �
Have you filed fa deduc6orvs in any oiher county? If Yes, what courrty7
❑ Yes ❑ No
VWe certify under penalty of perjury thal lhe above and foregoing information is true and correct and that the applicanf was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature d appinnt Pddress of apP�m (numEwantl stree4 ciN. sble, and ZlP mEe)
, XS,� �' . 7�
Signaturedauthwrzedrep ntative Adtlressotauthorizedrepreseniative (numbaraiMshee4aty.state,andLPcade)