Age_Craig;
�—� APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
l �' Sfam Fwm a3708 (R9 / 9-08)
Praacnbed by the DepaNneM of Lacal Govemmerit Finatrce
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Inforrtiation contained in Ihis Cocumenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1359.
COUNTY TOWNSHIP � YEAR
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I/ VJ I RVIi II VIYJ.
To be filetl !n person or by mail with the CourrtyAuCita o7 Ne wunry where fhe property is locafed. �A�U �� 200n
Fi(irq Dates: 1J Real Property: Dunng the tweNe (72) maMhs be/ae Decembe� 37 o/fhe ysar the deduction is 11Y btlbR �
2) Mobile Homes essessed unde� IC 6-7.7-7 ormanNadured homes irot assessed as real propeRy: Dunng Ihe MsAre (72) months
belore March 31 0l Ne year the deduction is to 6e eRecfive. `�i��� ��
See reverse sitle fa etltlitional instnictlons and qualificafions. ��
Typa d henef.I reuueste0 (plea5e rhMk a0 Naf appty)
❑ Over 65 Deduction 6om Assessed Valua6on
Name ol aDP���i (ownu/ a tonf2ct Eu}erJ � _
t_�(nn,cv� I(� �' �
U aODliwm tha sde lepal or apuitable owneR It No, whe� ie
❑ Yes ❑ No
tl name on record is diflareM Nan ihal d eop6��L �Micate behw
T��B
Duying m canVacf at leasf orre (1) Y�tl
ol mntratl se0er (numDer aM sbae4 ury, stafe, erH ZIP m0e)
❑ Yes ❑ No
oi age or rtare on December 31 of ihe year
� Yes ❑ No
Adjusted grosa income of applieanR $Pouse, and any
individuals sharing ownership (For Over 65 deduction, income
may not exceed 525, 000; /or the Over 65 Circuit Breaker Credif,
income may rrot exceed 530,000 for individuals, or 540.000 for
married couples).
Mava you fJeE tor erry other deCUCtions7
� Yes � No
tleductiona in any other murrty?
� Yes �lo
�ver 65 Circuit Breaker Credit
tt owned with someone oihar Ihan spoase.
inditlte with w�om
Is the o�oarry in puestion:
property � Mobile home (IC 6-7-f-�
IRecoN number
-c�/.6,57-aa 7
dedudron, a s1ti0Atn! ror mo
dale of birth (mmN, day, yea�
INJe certify under penalty of perjury that the above and foregoing information is irue and cortect and that the applicant was a resident
of Indiana and owner of the aforementloned property on March 1, 20 _
Slgnetu�e o/ euthorizeC rapreserrtative
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Addre88 of 8p0��M (��ber eiM sbael, city, sfate. aM Z/P cotla)
Addrav of eultarizad representative (numbar and sLeet. ciry, stafo, and LPcade)