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APPLICATION FOR SENIOR CITIZEN `L TOWNSHIP v� i
. PROPERN TAX BENEFITS _ � � j
` , Sdte Fortn 43708 (R9 / 9-08)
Prewibed by Me DeparLmerX of Loral GovemmeM Finaxe
O Infomiation oontained in this dowment is CONFIDENTIAL pursuant ta �C 6-1.1-12-9 and IC 61.735-9.
JUL 6F''e "(��`9
INSTRUCT10N5: ��/ ,(�-
To be fAetl ln person or by mail with fhe CountyAUtlita o/ fhe county where fhe property is locatetl. �' �` a"' �' �F
Fi1i�g Dates: i) Real Properfy: Dunrg the tweNe (72) mwAhs be/ae Decem6ei 37 of the year the deductios��� V
. TY AUDITOP.
2) Mo6Ne Homes essessed urMer IC frt. 7-7 or manu/actured homes rrot assessetl as real property: Dunrg fhe (weNe (72) monfhs
belore Marr/r 37 0/ fhe yeer the Ceduction is to be eRecfive.
See ieverse side la atlddional instrudions arM qualifications.
TYCe of berref,t reaueafeO (Wease theck e9 fha( a0M'1
❑ Over 65 Deduction 6om Assessed Valua6on �Over 65 Circuit Breaker Credit
Nemedeppfrcarit(mmerwcmf2ctbuye� '
�rn.c•� �'4��- °� a�. �rn . �a.�,�
1 pplKarh IhB Sde lepal or aQUitable amell 1( NO, Wh2� 19 ht9/llBf BX2L�lhd�B W in2Bf8517 tl axned wiih sroneone other Ihan spouse.
indimte with wtwm
❑ Yes ❑ No
M neme on tacord is diflarertl pan that d eppGran� indicala bebw
Name d mMrad seller (appGranf must hare bcan buy'ug on cronflad al loasf ona (7) yee�
Pdd�ess of contratl seller (number aM stree4 ciry, s6te, antl ZIP mde) is the v�oerry in ouesibn:
� Real properry � Mobile home (IC 6-14-�
� Taxi �atncl Key num6er / Legel description Reco(d number Page number
�jcLr�' aG -a0-16 -�oo-oov, 6�� -oo/
la Uie O�OeM1Y used end occupiad primarity br AssasveC value ot lha nmoerty as of March 7, wnent year (may nW oxcoetl 51B2,a30
hielner reaidence9 br Orer 65 deducfion, a Sf 60.000 /or the Ovar 65 Circuif &oeker Credi�
� Yes ❑ No
Waa t�e
applican; spouse, and any
Mave you fikd fw ary other de0ucaons? I it Wa. what deductionsl
Yes � No y
Have you (Jed for detl�ctions in any other wu If res, what coumy?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing intormation is true and cortect and lhat the applicant was a residenl
o( Indiana and owner of the aforementioned property on March 1, 20 _
�tura of epqiraM Addresa of aDDlipnt (n�mbarend stroef, ciry, sta:e, alM Z/P mde)
/' �Lhuo �!os S�Y S koo t+ o�k��� �: . /�✓ `�76Go
� iq �etura ot aWhonze0 ra0�entatne Mdress of auftwr¢ad re0�ese�ta�ive (numborarW sneef, ciry, slate. nd Z/P code)