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Age_SpindlerAPPLICATION FOR SENIOR CITIZEN � �
PROPERTY TAX BENEFITS
� ` , Sqfe Form 43708 (R9 / 9-08)
P�escnbad by the Departmeril ot Local Govemment Finance
COUNTY � TOWNSHIP � YEAR j
File Mark
Infortnetan contained in th�s dowment �s CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. ��-,d,, '��
INSTRUC710N5: tl
To be fileC ln persan oi by mail with the Co�MyAutlita o7 the counry wAere the propeAy is localed.
FAing Dates: 1) Reel Prt�perty: Durirg the hveNe (72) months belwe December 37 of fhe year the deduction is to �6e� +e7ffective,_� '(� p
2) Mobile Homes assessed unOer IC b f. f-7 or manWedured homes irof assessed as real piopeAy.tAUirg �e Fve0.MQf2) monNs
be/ae Ma� 37 0/ the year the de0uc6on is to 6e eflecWe.
See rererse side lar adddanel insLUCtions a� Qualificatlons. :/I7�,# �
// • �
rypeaea�ef+�eo�ertealp���xacrna�eaM� ,^;:;>ON COUNTY AUDITOR
❑
❑ No I
H neme on (amrtf b OEleram Man that d epp5mnt indicate bebw
Name
01 mntratl
axad
must have Dean by'up m tmtract ef least orre (7) Yea�
' a� abeat ciry. sble. a� ZIP code)
Key numbar / Leqal EescriDtion
, a� -a3-�� i�
s Uie D�M used end occupeE O�meM' br
iisThat reskenw)
Yes ❑ No
Nas tha epd�M 65 yean ot age w mora on December 31 of tt+e year
xior to the artenl yeaR
Yes ❑ No
AdJusted gross income of applicant, spouse, and any
individuals aharing ownership (ForOver 65 deduction, income
may not exceed 525,000; for fhe Over 65 Circuit Breaker Credit,
income may rrot exceed 830, 000 /or individuals, or 540,000 for
mamed couples).
Mava you fibd far arry alhar deEutEms?
Hava yau fileO tor deductions
IIWe certify under pe
of Indiana and owne
sq���re a aad�cam
� s " re°�
� Y85 �'�O
wumy?
� Yes No
�he
tl owned with mmaone ather than spouse,
indi�ate with wtrom
pmperty � Mobile home QC 644-�
mmber Pa9e numDar
Assessed valua o( the pfoperty as of Mamh 1, wrran� year (may irot erceetl
/or Orer 65 doducTian, ar 5166.000 lor Ne P.er 65 Cwicuit &oakw Crotliq
� ��
�y of perjury that the above and foregoing information is We and coirect and Ihat the applicant was a resident
the aforementioned property on March 1, 20
/ Address of apPlifant (num0er end stroeq city, sfafe, aM Z/P coEe)
��— / a 1�� S 5a W, -�� a,��oiqo�f ti1n �F��:
rtve AdEress of euthorixed rap�esentativa (numboran s:�eef. ciry. staro, anE ZIP cotle)