Age_Fritz (2)APPLICATION FOR SENIOR CITIZEN �� u r H YEAR
�: PROPERTY TAX BENEFITS �
, ...
S '• State Fortn 43708 (R9l 9-08)
Prescnbed by the Departmant of Lacal GovammeM Finance
Infortnatiom m�taine0 in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 ana IC 6-'1.1-35-9. � E C 1��""�
INSTRUCTIONS: ��/
To be filed in persm or 6y mail with the CountyAUdifor of t�e coun y whe�e the poperry is located. °' aG ��G
Filiry Dates: 1) RealProperty: Dunng the tweNe (12J months be/ore De�mber37 o/fhe yearthe tleducti���� e,fl�J�Y AUDITOR
2) Mobife Homes assessed under IC 6-7.7-7 or manulacture0 homes not assessed as real pmperty: Ounng the MsNe (72) months
be%re March 31 0l the year the deduttion is to be eNecfive.
See reverse side fa add'Riona/ insWClions arM qualifications.
Type o( 6eneft iapuesteC (ylaaso Meck a0 Nat appfy)
� Over 65 Deduction from Assessed Valuation � Over 65 Circuit Breaker Credit
Name of po�owner oi conhacl E�yo� .
V �C.� � 1"-�
Is a�ol�m ihe mle legzl or eQUita0le owneR If No, what is hiSRfar aiac �are o� inte�as�? tl o.vnac vntn so:neo^e ot�er than socuse,
inaicale wiL^, whort�.
❑ Yes ❑ No
11 name on record is ciRerenf tnan �hat ol ao����l indicata beiow �
Name ot cont2a sa�er (apWicanl must haw bean Ouying on confract at ba9 ono (f) yea�
� Address W contrea sellar (numDeraM sbeef. cify. sWlo. aM Z/P wde) Is t�e prpoefty in cueslion:
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I/.l Real pmpery � Mobile homa (IC 6-7-7-�
7"'
Tving is � � Key num6er I Lagal descnption I Record number Page number
�-/d-d��yoi-Do3.731-oa�
Is Lhe propeM w�' eM occuped pnmany br Assessed valua of the pmpahy as of Ma¢h l, curtent yezr (may nof axceotl5iH2,430
his/ner (esitleno7 hr O�er 65 doduaion, w 5160.000 for the Ovrv 65 Circuit &eakef Lretlin
Yes ❑ No
VJas lha eOdKem 65 yeara of aga w mara on Dacember 31 of tne year
Have you fded fw eery o�her ded�Gions? If Ves, what ceducfior.s?
,�Yes ❑ No � V
Hava you fiiad fN EadvcUOns in any othar wunty7 I( Ves. wnat county?
❑ Yes ❑ No
INJe certify under penalty of perjury that the above and foregoing information is We and correci and fhat the applirant was a resident
of Indiana and owner of the aforementioned property on March 7, 20 _
� Signatura W aGWirar.t Address of a001irant InumDerantl sVeet. ci.y, staro. arM ZIP cnCe)
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Signaturedauth �zea:eoresentaWe PAdressafauthwizecreoresentative (numbc�arMshoet.ciryf _ te,andZlPcode)
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