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" APPLICATION FOR SENIOR CITIZEN
t,. _rt � PROPERTY TAX BENEFITS
��-�' SbteFOrmd3708(R9/4-08)
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Prascnbe0 by Ne Oapartment of Local Govamment Finance
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Infwmation contained in this dowment a CONFIDENTIAL pursuaN to IC 6-1.1-12-9 and IC 6-7.bJ5-9.
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OU�JTY� � T,OWNS � P YEAR
DEC 12008
File Mark
�G� � �
INSTRUC710NS: G�BSQN CoU�7Y AUDITOR
To 6e filetl m person or by med wrth the CountyAudda ol Ne coun y where the property �s located.
Filing Detes: 1J Real PropeRy: Dunng the hveNe (72) monfhs 6e/ore Decem6er 37 o/fhe year (he tletlucfion is fo 6e eNective.
2) Mobile Hwnes assessed untler IC 6-7.7-7 or manu/actured hanes not assessed as real properfy: Dunng Ihe lweNe (72) mmths
be7ore Mardi 37 0! (he yeai fhe tletluction is (o be eHecfive.
See `everse side Iwedddional lnslnidions end qualificalions.
Type ol baneN raduested (p'oaso Mttk all lhef apply) .
❑ Over 65 Deduction 6om Assessed Valua6on Over 65 Circuit Breaker Credit
Name of apDGtaritlowna' ar cmhacl boyorJ %, /
• � � V
Is a0ofioert Ne sde lepal or eQUiWble owne�! II No, what u Ns/lier esad share or'v.teresfl It ownaE vrith wmeore cther Ihan spovse.
indirate wilh w"Wm
❑ Yes ❑ No
If neme m(ecord is Eiflerent Vian thal of aDd�n� indiwte bebw
Neme af conitaU salier (epdicanf mu5t hava bcan Cuyi�g on conUacf af loasl ono (f) yca�
AdCraaa ol mntrad saller (number aM sbeel, ciry, sfafo, aM ZIPCOEO) Is ihe pmoerty in Cuestirn:
� Real propery � Mobile home (IC 6-7-7-n
ITari disind Key numSeN Legal descnption I RacorE number Page num0er
pZ/v -�13-18-/00 -oo/ D�q-�d �
Is e D�ooeM used and occuped primady br
Have you (Jed Iw a�ry other deductiors7 It ves, wnat aeductior.$) '
ve5 ❑ r,o . � T �s
Hava you filed Iw EeduGions in any dher counry7 If Yes. wnal counry? �""
� Yes ❑ No
i/We certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signatwa d apd�nl Mdress of ap0lipr.( (numbe�antl sWef. cifj. sfalo. and ZIP tode)
,uf , .2 ��3 S �f 6 �,l/ ,�rc.
' Sipnature W eWhwized reo�esertative Pddress of aut�wizeC rao�asen�alive (nombn and strcef. tity. s+atc, and ZIP code)