Age_Cline� �' "' APPLICATION FOR SENIOR CITIZEN (� � c ewN na
r.. � PROPERTY TAX BENEFITS \ . I
� Sbte Fortn 43708 (R9/ 9-08j `.�
�, � Preacnbed by the Departmarit of loral Govemmem Finance
Informatbn owitained in Nis docvment is CONFIDENTIAL pursuant to IC 6-1.7-12-9 and IC F1.7-35-9. FC�III ..rr�coo�
INSTRUCTIONS: �� ��
To be filed /n persarr or by mail with the CourrtyAuddor o/ Ne couny where the property is locafed.
Filirq Dates: 1) Real Prnpe�ty.� During fhe hveNa (12) mmths 6e7ae Oecember 37 of fhe year tAe deduction is AI6S�1►ltR�OUNTY AUDITOR
2) Mobile Homes assessed under IC 67.7-7 or manufectured homes rrot essessed es real property.� Dunrg fhe txslve (12) mmfhs
befwe MarcA 37 07 the year fhe deUuction is to 6e eflecFive.
See ieverse side /or eddXionel lnsWCtions and quali6cafions.
Troe or eeoem rea�a�+m �p� me�.t ar u�a� apyy�
❑ Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of eDd� (��a' a' cmfiact Euye� .
'VW �W� _W�'w
u aooiKam the lepal or eQUitaMe ameR It No, wh� ia hivhar ezatl share w interesl7 tl amed with someone dher I�an soo�se.
indifate with wtwm
� ��p Na
H �ame an record'u Oiflarem ihan that d epo�ican� iMZata belo.v
Name d contact setler (eydicant mus! have bean 6uyirg an cartract at kast one (i) yearj
�
Pddresa o1 contrstl seller (numOOr aMatreet �'. sfafe, arid ZIP cade) Is �ha pmDerty in quesiron:
� � Real property ❑ Mobile home (IC G74-�
g diatnp Key numher / Lepal description I Record number Paga number
l�m bt6- ��l ab- �o -Qao s�e-o
is Ihe propaM � eM occupiee pAmariy br AssesseE value of the p'oDerry as ot Ma¢h 1, wrtent year (may nof exceetl SiB2.430
his/nerre�iden�? ' /orOwr65tlotludion,w4760.0001orI�oOver65Ciicuit&oakorCredit)
❑ Yes ❑ No
NSS lhe appGCant 65 yeara of aBe or more on Dacember 31 d the year
Nave yw filad (w a'ry dher tleEuctiona7 I( Yes. what deductionsl
Yes � No S,
Hava you fJed for deducGons in any ather wunty7 II!%s, what courry?
� Yes No
�IlWe certify under penalty of perjury that the above and foregoing infortnation is lrue and correct and that the applicant was a resident
of Indiana and owner of the aforemenlioned propeAy on March 1, 20
Signalura ¢aM AddresaotaDD����� (��berandsbcot,ciry,slale,andZlPCOde)
�� s. l u so fl. iN. �Tbbb
Sig atureofauthwizeEraO�esentaVVe AEdiessofaWhorizedre0�esenW�iva (num6erarrds'voaCCiry,state,anCL code)