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Age_Perry (3) p' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR I PROPERTY TAX BENEFITS t` .' pt----.- State Form 43708(R10/12-08) - Prescribed by the Department of Local Government Finance , ile l a a Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. p INSTRUCTIONS: AUG 1 9 2015 To be filed in person or by mail with the CountyAuditor of the county where the property is located. Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effecti . 2) Mobile Homes assessed under IC 5-1.1-7 or manufactured homes not assessed as real property' the before March 31 of the year the deduction is to be effective. COUNTY AUDITOR See reverse side for additional instructions and qualifications. Type of benefit requested(please check an that apply) ❑ Over 65 Deduction from If owned with someone other than spouse, indicate with whom ❑ Yes ❑ No If name on record is different than that of applicant,indicate below Name of contract seller(applicant must have been buying on contract at least one(1)year) Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: ❑ Real property ❑ Mobile home(/C 6-1-1-7) Taxing di Key number/Legal description Record number Page number si — ' /d-o Soo-CO ./%o 29 Is the properly used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430 his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit) ❑ Yes ❑ No Was the applicant 65 years of age or more on December 31 of the year Have you filed for any other deductions? If Yes,what deductions? n Yes ❑ No Have you filed for deductions in any other county? If Yes,what county? ❑ Yes ❑ No INVe certify under penalty of perjury that 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 . Signatu e oipplicant Address of applicant (number and street state,and ZIP code) ,Signature of authorized representative V Address offaauttnn ed representative (number and street,city state,and ZIP code) � APPLICATION FOR SENIOR CITIZEN > . -R' � PROPERTY TAX BENEFITS `�� J Sfab Fartn d3708 (R9/ 448) P`escnbed by ihe Departmam of Lacal Govemmem Fina�xe Infortnatam m�tained in Ihis doament is CONFIDENTIAL pursuant to IC 6-1.7-12-9 antl IC 61J35-9. COUNTY TOWNSHIP YEAR �' I L,F`�'`� INS7RUCT10NS: To be filetl in person or by mail w'rth the CourrtyAudita of Ne cou�y where the properfy is locatetl. A�p t C L U�U Fili�g Dafes: 7) Real PropeAy Dunrx� the MreNe (12J months belae December 37 o/fhe year fhe deduction is to b§Mfl�Ct"r.�. �� 2) Mo6Ne Homes essessed urrdei IC 6-7.7-7 or manWacturetl homes rrot assessed as real properly: Dunrg the tweAre (72) monfhs befpe Meich 37 0! the year Ihe deduGtion is to be eflecWe. `�1�� �� See ieverse sitle lw adddionel insWdions errd quelifications ��� Typa of benafit rapuasfed (yeese tl+eck a6lhaf apply) ❑ Over 65 Deduction from Assessed Valuation No H neme on rewrd'u EMalam than Name of contrap seiler AEdeass ot must hare beon buying m cmtrau at �oast orre (t) yoa� cM. stafo. aiW � Ta`zin9 d�i Key numcer I �egal descriolian '�G'Lc�� a�- �a-��-: Is Ne pmoerty used and occu0ie0 pri�narily for niv/ner rasidenw7 ' � Yes ❑ No Was the eo7��M 65 yean of epe or more on December 31 of the year wior to Me artem yeaR Yes ❑ No Adjusted gross ineome of applicant, spouse, and any individuals sharing ownership (FOrOver65 deducfion, income may not exceed 525.000; !or the Over 65 Circuit Breaker Credit, income may rrot exceed 530,000 for individuals, or 540,0001or married couples). Have ywi (lad for ary other deCUCEOns9 ❑ ves HavO yW filed fIX deducli0n9 in eny other muniy7 � Yes er 65 Cirwit Breaker Credit H ed with somaone olher lhan spa:se, i ' ta wi�h whom Is iha pmoe�ty in duestion: �eal property � Mobile home QC 6-1-7-� Record number Page r.umber o a-c�a. ��1,�-o d�' � sessed value of the O�oerry as of March 7, wrrani year (may not ezceed 5182.d30 O�er 65 tledudim, or 5160.000 for Ne Ovor 65 Circait Breakor CrediQ ol'�nfs date of birih (mmN. 0ay, yoa� I(filed by a wrviving, unmartied spouse, what was Ihe spousa's age al the time � �_ Artrount of Income iV J !1 i(\ M S , �t �� I( Ws, wnat deduwons? No � If T4s, what co�nryl S TOTAL I S 0.00 I/VJe certify under penalty of perjury that the above and foregoing information is tr�e and correct and that the applicant was a resident � Pddeass � sticel. ciry. stato.