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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)